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Complications of the treatment of endoscopic biliary strictures developing after liver transplantation
Author(s) -
Kobayashi Noritoshi,
Kubota Kensuke,
Shimamura Takeshi,
Watanabe Seitaro,
Kato Shingo,
Suzuki Kaori,
Uchiyama Takashi,
Maeda Shin,
Takeda Kazuhisa,
Nakajima Atsushi,
Endo Itaru
Publication year - 2011
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1007/s00534-010-0330-0
Subject(s) - medicine , endoscopic retrograde cholangiopancreatography , liver transplantation , pancreatitis , endoscopy , stent , univariate analysis , surgery , bile duct , orthotopic liver transplantation , transplantation , multivariate analysis
Abstract Background Bile duct strictures remain a major source of morbidity after orthotopic liver transplantation (OLT). Endoscopic management by the conventional methods of biliary dilatation and/or stent placement has been successful, but sometimes severe complications occur, necessitating prolonged therapy. The aim of this study is to clarify the complications of the endoscopic approach for endoscopic dilatation and/or stent placement. Method Of 46 patients who underwent living‐donor liver transplantation, 10 were diagnosed as having anatomic biliary strictures by endoscopic retrograde cholangiopancreatography (ERCP). Two patients developing biliary strictures after deceased‐donor liver transplantation were also enrolled in the study. For the purpose of comparison, 302 patients with a total of 550 consecutive ERCP cases (including 115 patients with 250 malignant bile duct strictures) were recruited in this study. Success rate, number of endoscopy sessions, the median procedure time for ERCP, and incidence of complications including post‐ERCP pancreatitis were compared in the OLT cases and other cases. Results The following results were obtained in the OLT cases, malignant stricture cases, and all cases, respectively: mean number of endoscopy sessions was 3.62, 2.17, and 1.94 ( p = 0.0216, p < 0.0001); post‐ERCP pancreatitis occurred in 5 (12.5%), 10 (4.0%), and 19 cases (3.5%) ( p = 0.0327, p = 0.0093); and severe pancreatitis occurred in 2 cases of OLT. In a univariate analysis for post‐ERCP pancreatitis, OLT was extracted as the only significant risk factor. Conclusions Endoscopic maneuvering for biliary dilatation and/or stent placement following OLT was associated with a higher risk of post‐ERCP pancreatitis than the use of the same technique for the treatment of malignant biliary stricture. Endoscopic treatment after OLT was a significant risk factor for post‐ERCP pancreatitis.