THE ROLE OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) IN THE MANAGEMENT OF BILIARY COMPLICATIONS ASSOCIATED WITH ORTHOTOPIC LIVER TRANSPLANTATION (OLT)

Aims:

To describe the prevalence of different biliary complications after OLT, their endoscopic management and the results obtained.

Methods:

Retrospective single center analysis including all OLT performed from January 2008 to December 2017. We collected demographic, clinical and endoscopic variables. Clinical success was accepted in patients reaching analytical normalization and not presenting symptoms for at least 6 months without stents in situ.

Results:

A total of 395 patients underwent OLT with a median age of 57.2 years (IQR: 50.9 – 62.9), 311 (78.7%) men. ERCP was performed in 155 patients (39.2%) due to analytical/radiographic suspicion of biliary complications. In 8 (5.2%) it was normal, in 106 (26.8%) a diagnosis was reached and 41 (10.4%) presented multiple diagnoses. The most frequent diagnoses were: anastomotic biliary stricture (28.6%), bile leak (4.8%), ischemic stenosis (3.5%), lithiasis (3.3%) and secondary sclerosing cholangitis (3%). The first examination was performed 110 days after transplantation (IQR: 34 – 323), with 3 (IQR: 2 – 4) procedures/patient, and a first to last ERCP interval of 8.3 (IQR 2.1 – 16.4) weeks.

Tab. 1:

Results in patients with a single diagnosis

	Patients (%)	ERCPs, med (IQR)	Interval 1st-last ERCP, (weeks) med (IQR)	Clinical success, (%)
Anastomotic stricture	86 (21.8%)	3 (2 – 4)	8.9 (3.4 – 18.6)	55 (64%)
Ischemic biliary stricture	5 (1.3%)	4 (3 – 4)	4.7 (1.4 – 6.4)	1 (20%)
Bile leaks	5 (1.3%)	4 (2 – 4)	11.6 (5.6 – 12.5)	4 (80%)
Lithiasis	5 (1.3%)	2 (1 – 2)	1.5 (1 – 4.1)	5 (100%)

ERCP was the first line of treatment in 147 (99.3%) cases. Twenty (13.6%) were in treatment at the end of the study period. Among the remaining 127, clinical success was achieved in 87 cases (68.6%), although 5 anastomotic biliary stenosis recurred after 9 months (range 6 – 37).

Conclusions:

Anastomotic biliary strictures are the main post-transplant biliary complication, occurring in 28.6% of our OLT. ERCP reaches clinical success in a high percentage of patients, although repeated procedures are usually required.