BILIARY-TRACT COMPLICATIONS AFTER ORTHOTOPIC LIVER-TRANSPLANTATION - ENDOSCOPIC APPROACH TO DIAGNOSIS AND THERAPY

This study was undertaken to further define the role of endoscopic met hods in the evaluation and treatment of biliary tract complications af ter liver transplantation and to determine the efficacy and safety of this approach, Fifty liver transplant patients were referred for endos copic evaluation of a suspected biliary tract complication, Two patien t groups were identified based on the indication for the endoscopic re trograde cholangiopancreatography (ERCP): Group 1 was suspected of hav ing biliary fistula and group 2 was suspected of having bile duct obst ruction, Group 1 consisted of 35 patients who developed bile peritonit is after inadvertent migration of the T-tube or intentional T-tube rem oval, Group 2 consisted of 15 patients who developed cholestatic hepat ic chemistries in the absence of allograft rejection on liver biopsy, ERCP identified a biliary fistula at the T-tube insertion site into th e bile duct in 32 (91%) group 1 patients. Twenty-six of 26 treated wit h a nasobiliary tube had fistula closure at a mean 5.2 days, Five of 6 treated with a stent, with or without sphincterotomy, had no leak at the time of stent removal (mean, 45 days), ERCP identified a cause for the cholestatic hepatic chemistries in 11 (73.5%) group 2 patients, i ncluding bile duct stones (n = 4), anastomotic (n = 3) or intrahepatic (n = 2) strictures, bile duct necrosis (n = 1), and hemobilia (n = 1) , Five of the 5 patients undergoing endoscopic therapy were treated su ccessfully, The endoscopic complication rate was 4% and the 30-day mor tality rate was 2%. During a mean follow-up of 15 months, 94% of the p atients who were treated successfully had no recurrent biliary tract d isease, The results of this study suggest that ERCP is an effective mo dality in the evaluation of patients with suspected biliary tract comp lications after liver transplantation. In selected patients, endoscopi c therapy obviates the need for additional surgical or percutaneous in tervention.