Endoscopic Management Of Biliary Complications After Orthotopic Liver Transplantation

Aim: To assess the indications and results of endoscopic retrograde cholangio-pancreatography (ERCP) in patients who underwent orthotopic liver transplantation (OLT).Methods: From October 2001 to October 2007, fifty-seven endoscopic retrograde cholangio-pancreatogrraphies (ERCPs) were performed in 11 patients after OLT in The First Affiliated Hospital of Guangxi Medical University in Nanning, China. The therapeutic maneuvers included endoscopic sphincterotomy (EST), biliary stent placement, balloon or catheter dilation, irrigation and nasobiliary tube placement. The types of biliary complications after OLT were reviewed and the success of ERCP and therapeutic maneuvers were evaluated.Results: Biliary complications after OLT including biliary leaking, biliary stricture and sludge and stone formation were treated respectively by endoscopic sphincterotomy(EST) with sludge extraction, stricture dilation or endoscopic retrograde biliary drainage. Cholangiograms performed in 11 patients displayed anastomotic strictures in 9 patients (82%), sludge in 5 (45%), both sludge and anastomotic stricture in 4 (36%), proximal common bile duct stricture in 1 (9%) and both proximal common bile duct stricture and rarity with sludge formation in 1 (9%). Anastomotic stricture dilation was achieved effectively in 6/9 patients (67%) by dilation and stent placement, while sludge extraction was successfully treated in 4/5 (80%) patients by dilation, stent placement or endoscopic nosobiliary drainage. No severe ERCP-related complications were observed and there was no mortality in these cases.Conclusions: Most cases of biliary complication after liver transplantation are anastomotic stricture and sludge formation. Endoscopic sphincterotomy and stent placement seems to be the best and durable treatment for the patients. But endoscopy-based treatment cannot deliver effective therapeutic effects for patients with intra-hepatic stricture and rarity. ERCP is a safe, effective and accurate mode for the diagnosis and management of bile duct complications after OLT. It should be the first choice maneuver before a surgical approach.