PROSPECTIVE-STUDY OF HEPATOBILIARY SCINTIGRAPHY AND ENDOSCOPIC CHOLANGIOGRAPHY FOR THE DETECTION OF EARLY BILIARY COMPLICATIONS AFTER ORTHOTOPIC LIVER-TRANSPLANTATION

Background Biliary complications are a significant cause of morbidity and death after orthotopic liver transplantation (OLT). This study was a prospective evaluation of endoscopic retrograde cholangiography (ER C) and hepatobiliary scintigraphy (HBS), using Tc-99m Mebrofenin, to d etect early biliary complications following OLT. Methods One hundred c onsecutive patients who had OLT with a biliary duct-to-duct anastomosi s were studied. Of these, 67 had both ERC and HBS performed within 30 days of OLT. Sensitivity, specificity and diagnostic accuracy of HBS i n identifying biliary leak or stricture was calculated. Results Of the 67 cholangiographies performed 45 were normal, In 22 patients there w as radiological evidence of a leak (n = 14) or stricture (n = 8) which required further intervention in nine and four patients respectively. The sensitivity and specificity of scintigraphy for the detection of biliary leak after transplantation was 50 and 79 per cent and for bili ary stricture 62 and 64 per cent respectively. No patient with normal scintigraphy required biliary intervention. Only six of 14 patients wi th biliary leaks and two of 20 with strictures suggested by scintigrap hy required intervention. If both ERC and HBS reported leak or strictu re, the intervention rate was considerably higher at five of seven lea ks and two of five strictures. Conclusion This study suggests that sci ntigraphy is a useful screening test for biliary complications after O LT. ERC is only necessary if HBS is abnormal.