Endoscopic Treatment Of Biliary Obstrution In Patients With Orthotopic Liver Transplantation

Objective To investigate the safety and efficacy of Endoscopic retrograde cholangiopancreatography(ERCP)in the treatment of patients with biliary obstructions after liver transplantation(LT).Methods Clinical data of 29 patients with biliary obstructions after LT treated with ERCP in the Fuzhou General Hospital of Fujian Medical University between January 2005 and December 2017 were analyzed retrospectively.Indexes including degree of biliary obstruction,ERCP treatment condition and the hepatic function changes and prognosis of 29 patients with biliary obstruction after LT were recorded by endoscopic treatment.Wilcoxon signed-rank test was used to compare with serum TBil,ALP,GGT,ALT and AST levels before and after ERCP treatment.Results 4 patients of anastomotic biliary strictures,9 patients of common bile duct stones and bile duct stenosis,11 patients of common bile duct stones,and 5 patients of intrahepatic and extrahepatic bile duct stones in 29 patients.The median time from LT to bile duct obstructions diagnosis was(534±180)d.19 patients developed between 12 to 66 months after LT,4 patients developed between 4 to 12 months after LT and the remaining 6 patients developed within 3 months after LT.24 cases had common bile duct stones removed successfully with Endoscopic balloon dilation combined with stenting and internal bile duct drainage,4 cases had bile duct stenosis removed successfully with Endoscopic balloon dilation combined with stenting and internal bile duct drainage.TBil,ALP and GGT were 30,182 and 238 mmol/L after endoscopic treatment.Both were lower than the pre-endoscopic treatment levels(47,273,and 369 mmol/L).As of December 2018,29 patients were followed up for 1 to 2 years,4 cases died of primary liver cancer at 9,5,34,and 25 months after LT,and 1 patient had developed upper gastrointestinal bleeding.He had died at 34 months after liver transplantation,1 patient underwent secondary liver transplantation due to severe biliary stenosis and died of septic shock due to liver abscess in April 2014,1 patient underwent septic shock after liver transplantation,and 1 patient underwent acute hepatic failure.No stones or obstructions were found in the remaining 21 patients during the follow-up period.Conclusions According to the above clinical analysis,duodenal endoscopic balloon dilatation combined with multiple plastic stents or endoscopic nasobiliary drainage is safe,effective and feasible for the treatment of biliary obstruction after LT.