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Revista Colombiana de Gastroenterologia

Print version ISSN 0120-9957

Abstract

CASTANO LLANO, Rodrigo et al. Endoscopic management of biliary complications following orthotopic liver transplantation. Rev Col Gastroenterol [online]. 2012, vol.27, n.3, pp.173-184. ISSN 0120-9957.

Background. Complications of bile duct reconstruction following liver transplantation are common and are an important cause of morbidity and mortality. Currently, endoscopic retrograde cholangiopancreatography (ERCP) is an attractive alternative for management of biliary complications. It has high diagnostic and therapeutic utility, is less invasive than other techniques and has low morbidity. The aims of this study are to evaluate the results of endoscopic management of patients with biliary complications following liver transplantation, and to then determine risk factors and their impacts on patient survival. Materials. We reviewed the medical records of patients with biliary complications following liver transplantation who were admitted to the Hospital Pablo Tobón Uribe between January 2002 and December 2010. Cases were reviewed whether or not patients had undergone transplantation at this center. Results. 148 ERCPs were performed on 50 patients (30 men and 20 women). Average patient age was 47 years (5 to 71 years old). Average follow up time was 44 months. 42 biliary strictures in  (33 anastomotic and 9 non anastomotic), 4 fistulas, 3 filling defects (stones or bile casts) and 1 papillary stenosis (Oddi dysfunction) were found. Strictures were managed with plastic (30 patients) prostheses or, since 2008, with metal prostheses (12 patients). 94% of cases of non-ischemic stenosis improved with biliary stents. There were no significant differences in outcomes between plastic and metal prostheses, but there was a significant reduction in the number of ERCPs needed in the metal stent group (84 versus 28). Fistulas were closed with plastic stents in three of the four patients. Three patients had stones that were successfully removed. One patient with papillary stenosis improved after sphincterotomy. Complications occurred in 8 patients: four cases of bleeding (all controlled endoscopically), three cases of mild pancreatitis, and one patient with sepsis that recovered with antibiotic treatment. Multivariate analysis showed a significant association of anastomotic strictures with patient age (p = 0.002). The overall survival analysis showed that the probability of survival for 40 months after liver transplantation is 0.745. There were no differences among transplant patients without biliary complications. Conclusions. Endoscopic cholangiography is safe and effective for the diagnosis and management of biliary complications following hepatic transplantation. The only factor which showed a direct relationship with the possibility of biliary complications was age. The survival of the group with biliary complications did not differ from transplant patients without biliary complications.

Keywords : Liver transplantation; biliary stent; biliary stricture; biliary fistula; biliary drainage.

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