title: Safety and yield of diagnostic ERCP in liver transplant patients with abnormal liver function tests.
abstract: Background. Abnormal liver enzymes postorthotopic liver transplant (OLT) may indicate significant biliary pathology or organ rejection. There is very little known in the literature regarding the current role of diagnostic ERCP in this scenario. Aim. To review the utility of diagnostic ERCP in patients presenting with abnormal liver function tests in the setting of OLT. Methods. A retrospective review of diagnostic ERCPs in patients with OLT from 2002 to 2013 from a prospectively maintained, IRB approved database. Results. Of the 474 ERCPs performed in OLT patients, 210 (44.3%; 95% CI 39.8-48.8) were performed for abnormal liver function tests during the study period. Majority of patients were Caucasian (83.8%), male (62.4%) with median age of 55 years (IQR 48-62 years). Biliary cannulation was successful in 99.6% of cases and findings included stricture in 45 (21.4 %); biliary stones/sludge in 23 (11%); biliary dilation alone in 31 (14.8%); and normal in 91 (43.3%). Three (1.4%) patients developed mild, self-limiting pancreatitis; one patient (0.5%) developed cholangitis and two (1%) had postsphincterotomy bleeding. Multivariate analyses showed significant association between dilated ducts on imaging with a therapeutic outcome. Conclusion. Diagnostic ERCP in OLT patients presenting with liver function test abnormalities is safe and frequently therapeutic.
authors.affiliation: Division of Gastroenterology and Hepatology, Endoscopic Ultrasonography, Basil Hirschowitz Endoscopic Center of Excellence, University of Alabama at Birmingham, BDB 389, 1808 7th Avenue South, Birmingham, AL 35294, USA ; Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL 32803, USA.
authors.forename: Jayapal
authors.identifier: 0000-0001-6573-1371
authors.initials: J
authors.lastname: Ramesh
authors.affiliation: Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL 32803, USA.
authors.forename: Nipun
authors.initials: N
authors.lastname: Reddy
authors.affiliation: Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL 32803, USA.
authors.forename: Hwasoon
authors.initials: H
authors.lastname: Kim
authors.affiliation: Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL 32803, USA.
authors.forename: Klaus
authors.initials: K
authors.lastname: Mönkemüller
authors.affiliation: Center for Interventional Endoscopy, Florida Hospital, Orlando, FL 35294, USA.
authors.forename: Shyam
authors.initials: S
authors.lastname: Varadarajulu
authors.affiliation: Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL 32803, USA.
authors.forename: Brendan
authors.initials: B
authors.lastname: McGuire
authors.affiliation: Department of Liver Transplantation Surgery, University of Alabama at Birmingham, Birmingham, AL 32803, USA.
authors.forename: Derek
authors.identifier: 0000-0001-8053-9695
authors.initials: D
authors.lastname: DuBay
authors.affiliation: Department of Liver Transplantation Surgery, University of Alabama at Birmingham, Birmingham, AL 32803, USA.
authors.forename: Devin
authors.identifier: 0000-0003-2621-1431
authors.initials: D
authors.lastname: Eckhoff
authors.affiliation: Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL 32803, USA.
authors.forename: C Mel
authors.initials: CM
authors.lastname: Wilcox
references.citation: Endoscopy. 2013 Jul;45(7):567-70
references.pmid: 23580410
references.citation: Am J Gastroenterol. 2000 Jan;95(1):141-4
references.pmid: 10638573
references.citation: Endoscopy. 2005 Sep;37(9):857-63
references.pmid: 16116539
references.citation: Gastrointest Endosc. 2011 May;73(5):955-62
references.pmid: 21316670
references.citation: Gastrointest Endosc. 2002 Feb;55(2):224-31
references.pmid: 11818927
references.citation: Am J Gastroenterol. 2001 Oct;96(10):2900-4
references.pmid: 11693324
references.citation: Endoscopy. 2009;41 Suppl 2:E4-5
references.pmid: 19177293
references.citation: J Hepatobiliary Pancreat Surg. 2006;13(6):487-96
references.pmid: 17139421
references.citation: Liver Transpl. 2009 Nov;15(11):1493-8
references.pmid: 19877248
references.citation: Gastrointest Endosc. 2011 Aug;74(2):285-94
references.pmid: 21704993
references.citation: Gut Liver. 2011 Sep;5(3):328-34
references.pmid: 21927662
references.citation: Liver Transpl. 2012 Dec;18(12):1479-84
references.pmid: 22888069
references.citation: Liver Int. 2003 Jun;23(3):156-62
references.pmid: 12955878
references.citation: Am J Transplant. 2013 Feb;13(2):253-65
references.pmid: 23331505
references.citation: World J Gastroenterol. 2007 May 28;13(20):2819-25
references.pmid: 17569117
references.citation: Gastrointest Endosc. 1991 May-Jun;37(3):383-93
references.pmid: 2070995