ENDOSCOPIC RETROGRADE CHOLANGIOGRAPHY IN THE DIAGNOSIS AND ENDOSCOPICMANAGEMENT OF BILIARY COMPLICATIONS AFTER LIVER-TRANSPLANTATION

Objective: Biliary reconstruction in orthotopic liver transplantation is increasingly being performed without T tube drainage. This increase s the difficulty of diagnosing subsequent biliary tract problems, with a greater reliance placed on endoscopic retrograde cholangiopancreato graphy (ERCP) for the diagnosis of biliary tract complications. The us efulness of ERCP was evaluated in patients who underwent liver transpl ant where biliary reconstruction was not done with T tube drainage. De sign and participants: A retrospective study of the case notes of 90 p atients who underwent liver transplantation, and in whom the biliary r econstruction was by end to end choledochocholedochostomy without T tu be splintage. Results: ERCP was performed as the primary procedure to investigate a suspected biliary complication in 30 patients (33%). The procedure was successful in 26 patients (87%), and showed a biliary s tricture in 12 patients and a bile leak in six patients. ERCP was norm al in seven patients and demonstrated dilated ducts alone in one patie nt. Six of the biliary strictures were successfully dilated endoscopic ally (50%), but none of the bile leaks resolved with endoscopic draina ge. Conclusion: This study confirms the diagnostic role of ERCP post l iver transplant. The therapeutic role requires clearer evaluation with a controlled trial.