ENDOSCOPIC MANAGEMENT OF BILIARY COMPLICATIONS AFTER ORTHOTOPIC LIVER-TRANSPLANTATION

Background/Aims: Biliary complications after orthotopic liver transpla ntation, are still a severe problem and often. require a second surgic al operation. Material and Methods: In our center rue studied 500 pati ents after liver transplantation. Results: In this patient population, we found 44 patients suffering from diseases of the bile duct system after Liver transplantation Biliary complications were caused by steno ses which were Localized most often in the common bile duct of the rec ipient (65%) but also in. the common bile duct of the donor liver (26% ) as well as in, the anastomosis of common bile duct (9%). In all case s ERC was able to identify Location, entity and dimension of the bilia ry complication thus Leading to therapeutic strategy. 66% (27 out of 4 1) of the patients with biliary complication could be cured definitely by endoscopic methods alone while 29% (12 out of 41) of these patient s needed surgical operation, and 5% (2 out of 41) received both, endos copic and surgical therapy. Patients suffering from multiple complicat ions could be cured partially by endoscopic methods improving patient condition for subsequent surgery. Ischemic type biliary lesions of the extrahepatic ducts (ITBL type I) as well as of the intrahepatic ducts (ITBL type II) could be successfully treated by endoscopy. Only rare cases of multiple lesions intra- and extrahepatically due to ITBL type III gave no chance to endoscopy and demanded directly surgical operat ion. Conclusions: Our results show that most of the biliary complicati ons after liver transplantation can be resolved by endoscopic treatmen t.