ENDOSCOPIC DIAGNOSIS AND MANAGEMENT OF BILIARY COMPLICATIONS FOLLOWING ORTHOTOPIC LIVER-TRANSPLANTATION

Nonoperative management of biliary complications (BC) with endoscopic retrograde cholangiopancreatography (ERCP) is a natural sequel to the emergence of choledochocholedochostomy as the preferred biliary recons truction for orthotopic liver transplantation (OLT). Overall, therapeu tic ERCP's efficacy for posttransplant BC is difficult to assess becau se most published data are retrospective, anecdotal, or in abstract fo rm, and there are no prospective, randomized studies. Thus, endoscopic management of posttransplant BC must be individualized. While T-tube- related late bile leaks and ductal calculi are amenable to endoscopic therapy, its efficacy for strictures is more difficult to define. Refi ned surgical technique has prevented many unifocal anastomotic lesions , while multifocal strictures (for which endoscopic therapeutic experi ence is minimal) are increasingly prevalent. Whether endoscopic sphinc terotomy is appropriate for posttransplant sphincter of Oddi dysfuncti on is controversial, because the disorder may be transient and the ris k significant. Multicenter, prospective studies are needed to determin e more accurately the optimal role of endoscopic therapy after OLT.