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

Background/AimsEndoscopic 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.MethodsThe 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).ResultsOf 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).ConclusionsERCP is safe and effective for the treatment of post-OLT biliary complications, has a low rate of pancreatitis and results in a durable effect.

Endoscopic treatment of anastomotic biliary strictures after living donor liver transplantation: outcomes after maximal stent therapy

“…22 With contemporary surgical techniques, non-ABSs are relatively uncommon, occurring in less than 5% to 15% of liver transplant recipients. 20 ABSs develop from the choledochocholedochostomy or the choledochojejunostomy site and remain a common problem after transplantation; they constitute as much as 40% of biliary complications. 23 ABSs are a potential problem for all liver transplant recipients, but are particularly a problem after LDLT.…”

“…20 Posttransplantation biliary strictures are classified broadly as non-ABSs or ABSs. Non-ABSs involve donor hepatic ducts as a result of hepatic artery thrombosis 21 or ischemia.…”

Endoscopic versus surgical management of biliary complications – Outcome analysis after 1188 orthotopic liver transplantations

“…Nevertheless in some cases ERCP might not result in a definitive treatment for patients presenting with biliary concrements or strictures [14][15][16] resulting in multiple endoscopic re-interventions. Furthermore, long-term follow-up data on outcomes and complications after ERCP in liver transplant patients is scarce [17].…”

Acute pancreatitis following adult liver transplantation: A systematic review

“…As a result, patients frequently require therapeutic endoscopic retrograde cholangiography (ERCP), which can result in post-ERCP pancreatitis (PEP). A recent large systematic review of the placebo or no stent arms of PEP prophylaxis trials reported PEP rates at 9.7% and 14.7% in average-risk and high-risk patients, respectively (35)(36)(37). A number of studies in the post-liver transplant population have demonstrated lower rates of PEP varying between 1% and 6.4% (38), with 2 studies showing that PEP is responsible for 11% of post-liver transplant pancreatitis (4,7).…”