title: Safety and efficacy of endoscopic retrograde cholangiopancreatography in patients with post-liver transplant biliary complications: results of a cohort study with long-term follow-up.
abstract: OBJECTIVE
  Endoscopic retrograde cholangiopancreatography (ERCP) is the standard approach for the management of biliary complications in liver transplant patients; however, its safety and efficacy have not been established in this setting. This study was performed to evaluate the safety and long-term efficacy of ERCP in transplant patients.
  
  
  METHODS
  The case reports of 1,500 liver transplant patients were reviewed. Orthotopic liver transplantation (OLT) patients were matched 1:2 with non-OLT patients and followed-up for long-term outcome (median, 7.4 years).
  
  
  RESULTS
  Of the 1,500 liver transplant patients, 94 (6.3%) underwent 150 ERCPs after OLT. Anastomotic strictures were present in 45 patients, biliary stones in 24, biliary leaks in 7, papillary stenosis in 2, and primary sclerosing cholangitis in 1. An ERCP success rate of 90.7% was achieved; biliary stenting led to resolution of the bile leak in 7/7 (100%) patients, and biliary stones were removed in 21/24 (87.5%) patients. In addition, 34 of 45 patients with anastomotic stricture underwent endoscopic dilation. We obtained complete resolution in 22/34 (64.7%) patients. OLT patients did not show a higher probability of complications (odds ratio [OR], 1.04), of pancreatitis (OR, 0.80) or of bleeding (OR, 1.34).
  
  
  CONCLUSIONS
  ERCP is safe and effective for the treatment of post-OLT biliary complications, has a low rate of pancreatitis and results in a durable effect.
authors.affiliation: Department of Gastroenterology, University of Turin, Molinette Hospital, Turin, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Sanna
authors.forename: Chiara
authors.initials: C
authors.lastname: Giordanino
authors.forename: Ilaria
authors.initials: I
authors.lastname: Giono
authors.forename: Claudio
authors.initials: C
authors.lastname: Barletti
authors.forename: Arnaldo
authors.initials: A
authors.lastname: Ferrari
authors.forename: Serafino
authors.initials: S
authors.lastname: Recchia
authors.forename: Dario
authors.initials: D
authors.lastname: Reggio
authors.forename: Alessandro
authors.initials: A
authors.lastname: Repici
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ricchiuti
authors.forename: Mauro
authors.initials: M
authors.lastname: Salizzoni
authors.forename: Ileana
authors.initials: I
authors.lastname: Baldi
authors.forename: Giovannino
authors.initials: G
authors.lastname: Ciccone
authors.forename: Mario
authors.initials: M
authors.lastname: Rizzetto
authors.forename: Giorgio
authors.initials: G
authors.lastname: Saracco