Endoscopic versus surgical management of biliary complications - Outcome analysis after 1188 orthotopic liver transplantations.
OBJECTIVE
After liver transplantation, the endoscopic approach has become the standard treatment modality for biliary complications. Aim of this study was to compare primary endoscopic with primary surgical management.


METHODS
A retrospective review on 1188 consecutive liver transplant patients between 1989 and 2009 was performed. Management strategies (endoscopic, surgical or combined approach) were evaluated for treatment success as well as patient survival.


RESULTS
Biliary complications after liver transplantation were diagnosed in 211 (18%) patients. Initial endoscopic approach (N=162, 77%) was successful in 97 of 162 (60%) patients. In 80% of patients, success was achieved within a median of four ERCPs. Sixty-one patients (38%) were referred to surgery after non-successful ERCP. Initial surgical approach was performed in 49/211 patients (23%) with successful management in 38/49 (78%) of patients. Patients presenting with intraluminal objects needed a significantly higher number of ERCPs to reach treatment success (median 3 versus 2 interventions, p=0.001) but had an equal endoscopic success rate (p=0.427). Patients with successful endoscopic treatment showed lower mortality compared to patients with primary surgical treatment (p=0.029).


CONCLUSIONS
Endoscopic management should be considered as the primary approach for biliary complications after liver transplantation.
Department of Surgery, Division of Transplantation, Medical University Vienna, Vienna, Austria.
Georg P
GP
Györi
Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University Vienna, Vienna, Austria.
Remy
R
Schwarzer
Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University Vienna, Vienna, Austria.
Andreas
A
Püspök
Department of Internal Medicine IV, Krankenhaus der Elisabethinen Linz, Austria.
Rainer
R
Schöfl
Department of Surgery, Division of Transplantation, Medical University Vienna, Vienna, Austria.
Gerd R
GR
Silberhumer
Department of Surgery, Division of Transplantation, Medical University Vienna, Vienna, Austria.
Felix B
FB
Langer
Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University Vienna, Vienna, Austria.
Michael
M
Trauner
Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University Vienna, Vienna, Austria.
Markus
M
Peck-Radosavljevic
Department of Surgery, Division of Transplantation, Medical University Vienna, Vienna, Austria.
Gabriela A
GA
Berlakovich
Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University Vienna, Vienna, Austria. Electronic address: arnulf.ferlitsch@meduniwien.ac.at.
Arnulf
A
Ferlitsch
D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001317:Austria; D001660:Biliary Tract Diseases / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
Biliary anastomosis; ERCP; Endoscopy; Hepaticojejunostomy; Surgery