title: Endoscopic Treatment of Early Biliary Complications in Liver Transplant Recipients.
abstract: BACKGROUND
  The most common complications following liver transplantation (LTx) concern the biliary ducts. Potential early complications are biliary leaks and anastomotic strictures of the bile duct. The aim of this study was to evaluate the efficacy of endoscopic treatment of early biliary complications in liver transplant recipients after end-to-end biliary anastomosis.
  
  
  METHODS
  From January 2011 to December 2013, 475 patients underwent LTx at our Department. There were 101 endoscopic procedures performed in total during this period, out of which 67 were related to biliary complications in 44 patients, while the remaining procedures were carried out due to gastrointestinal bleeding. We established a timeframe of up to 3 months postoperatively as the early biliary complication period. With the selected criteria we retrospectively analyzed medical records of 24 liver recipients who underwent endoscopic treatment due to early biliary complications. The outcome of endoscopic treatment was statistically analyzed and categorized as a technical and clinical success.
  
  
  RESULTS
  During this period there were 38 endoscopic procedures in the analyzed group of patients treated due to early biliary complications. The results were: successful balloon dilation alone was performed in 2 patients with no further need of treatment, implantation of plastic stents was performed initially in 13 patients, but 7 patients required further stenting with larger caliber plastic stents (PS). Self-expandable metal stents (SEMS) were initially placed in 7 patients during this period overall. One patient was treated due to hemobilia. In 1 case endoscopic retrograde cholangiopancreatography (ERCP) was unfeasible and the patient required surgical intervention. In 1 case a PS was exchanged for an SEMS. Six patients with satisfactory cholangiography images had the stent removed during the second ERCP.
  
  
  CONCLUSIONS
  In consideration of the stabilized rate of biliary complications following LTx, an advanced transplant center cannot function without an experienced endoscopist. For early biliary leaks and anastomotic strictures, ERCP is the primary treatment.
authors.affiliation: Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Konrad
authors.initials: K
authors.lastname: Kobryń
authors.affiliation: Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Sławomir
authors.initials: S
authors.lastname: Kozieł
authors.affiliation: Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Marta
authors.initials: M
authors.lastname: Poręcka
authors.affiliation: Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Kobryń
authors.affiliation: Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Wacław
authors.initials: W
authors.lastname: Hołówko
authors.affiliation: Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Waldemar
authors.initials: W
authors.lastname: Patkowski
authors.affiliation: Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Zieniewicz
authors.affiliation: Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Tadeusz
authors.initials: T
authors.lastname: Wróblewski
authors.affiliation: Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Krawczyk
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D057868:Anastomotic Leak / Q000175:diagnosis / Q000601:surgery; D001660:Biliary Tract Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D002779:Cholestasis / Q000175:diagnosis / Q000601:surgery; D015331:Cohort Studies; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011044:Poland; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome