Endoscopy 2018; 50(04): S71-S72
DOI: 10.1055/s-0038-1637239
ESGE Days 2018 oral presentations
21.04.2018 – ERCP 3: Hot topics and post liver transplantation
Georg Thieme Verlag KG Stuttgart · New York

EFFICACY AND SAFETY OF DEVICE-ASSISTED ENTEROSCOPY ERCP IN LIVER TRANSPLANTATION: A SYSTEMATIC REVIEW WITH META-ANALYSIS

F Ferretti
1   Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy
,
M Fraquelli
1   Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy
,
G Casazza
2   Università degli Studi di Milano, Department of Biomedical and Clinical Sciences, Milan, Italy
,
F Branchi
1   Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy
,
R Penagini
1   Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy
,
P Cantù
1   Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy
,
S Orlando
1   Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy
,
M Vecchi
1   Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy
,
L Elli
3   Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Center for Prevention and Diagnosis of Celiac Disease, Milan, Italy
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Publikationsverlauf

Publikationsdatum:
27. März 2018 (online)

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Aims:

Enterobiliary anastomosis are one of the main source of complications affecting up to 50% of liver transplanted patients. Even if not standardized yet, a diagnostic and therapeutic approach combining device-assisted enteroscopy and traditional ERCP (DAE-ERCP) is technically possible in patients with altered anatomy. The aim of the present study is to assess the efficacy, feasibility and safety of DAE-ERCP in the subset of liver transplanted patients (LT) compared to non-transplanted patients (non-LT).

Methods:

A systematic review and meta-analysis of studies involving DAE procedures in LT patients published between January 2000 and May 2017 was conducted in MEDLINE (via PubMed) and Embase. The main endpoints were: endoscopic, diagnostic, therapeutic and overall success rates, type of enteroscopy, complications and the need to recur to surgery after failed endoscopy.

Results:

A total of 155 studies were retrieved; of these, six relevant trials were analyzed. Single and double-balloon enteroscopy were included. Overall, 132 subjects (72 LT versus 60 non-LT controls) undergoing 257 DAE-ERCP (135 LT versus 122 non-LT) were analyzed. Complications were rare and mild (4/257), no death occurred.

Comparing the pooled success rates among LT and non-LT patients, no significant difference was found in enteroscopic (80%-100% LT vs. 82%-95% non-LT), diagnostic (75%-100% LT vs. 89%-100% non-LT), therapeutic (67%-100% LT vs. 92%-100% non LT) and overall success rate (60 – 100% LT vs. 79%-83% non LT). Test for heterogeneity did not show any statistical significance. Likewise, the recurrence to surgery was not statistically different between the two subgroups (0%-50% LT vs. 18 – 33% non-LT).

Conclusions:

Biliary complications following liver transplantation are a major cause of morbidity and mortality. In this challenging subset of patients, the high diagnostic and therapeutic success rates of DAE-ERCP combined with its safety and feasibility encourages its employ as a first-line approach for transplanted patients.