Curative Effect Analysis Of Endoscopic Retrograde Cholangiopancreatography In The Treatment Of Biliary Complications After Liver Transplantation

Objective: To evaluate the efficacy and safety of ERCP in the treatment of biliary complications after liver transplantation.Methods: The clinical data of patients with biliary complications and ERCP treatment after liver transplantation admitted to the first affiliated hospital of guangxi medical university from November 2011 to November 2018 were retrospectively analyzed.The biliary complications such as biliary stricture,biliary calculi,bile leakage and biliary tract infection after liver transplantation were counted,as well as the ERCP treatment measures and ERCP-related complications,and the data of patients undergoing PTCD surgery due to biliary tract complications after liver transplantation were compared.Results: 23 cases of biliary complication after liver transplantation in parallel ERCP in the treatment of patients,23 cases of male and female 0 cases,aged 36 ~ 65,mean age 49.61 ± 8.24 years,ERCP 91 times that 9 times failure,operation success rate 90.1%,the average line of ERCP for 3.96 ± 2.23 times,cured by ERCP in 16 cases,4 cases were improved,invalid in 3 patients,treatment effective rate was 87.0%(20/23).Of the 23 patients,21 had biliary stricture after liver transplantation.There were 16 cases of choledocholithiasis.Bile leakage in 5 cases;Biliary tract infection in 8 cases;73.9%(17/23)patients had two or more biliary tract complications at the same time.The stricture of biliary tract was mainly treated with ERBD+ distension,the stones were mainly treated with ERBD+ distension + stasis,the infection was mainly treated with ERBD,the bile leakage was mainly treated with EST+ERBD.Complications occurred after ERCP in 7 patients(30.4%),acute pancreatitis in 3 patients,and stent malposition,detachment or blockage in 5 patients,of which 1 patient was combined with pancreatitis and stent obstruction(died of biliary hemorrhage and hemorrhagic shock on the third day after PTCD surgery),and the remaining 6 patients were improved after treatment.Up to March 2019,the time of biliary tract complications,the survival time after liver transplantation and the survival time after ERCP were 8 months,86.57±49.59 months and 20 months,respectively.A total of 3 cases(13.0%)died,including 1 case of liver cancer recurrence and metastasis,1 case of pulmonary embolism and respiratory failure,1 case of biliary hemorrhage and hemorrhagic shock after PTCD surgery,and no death cases related to ERCP operation.A total of 3 cases of PTCD were collected from patients with biliary complications after concurrent liver transplantation.All 3 patients had anastomotic stenosis,including 1 patient with bile leakage.3 days after PTCD,he died of biliary hemorrhage and hemorrhagic shock.One case was complicated with choledocholithiasis.After PTCD treatment,anastomotic stricture and calculus were not relieved.After 20 days,choledochotomy,exploration and stone extraction were performed,and choledocholithiasis was cured after choledocholithotomy.One case was complicated with intrahepatic bile duct calculi.On the 12 th day after PTCD surgery,the drainage tube was displaced and PTCD was not performed again.Conclusion: ERCP is safe and effective in the treatment of biliary complications after liver transplantation,which can effectively improve the quality of life of patients,and is the preferred treatment for biliary complications after liver transplantation.