Late biliary tract complications after orthotopic liver transplantation: Diagnostic and therapeutic role of endoscopic retrograde cholangiopancreatography

Background: Biliary tract complications are frequent after orthotopic liver transplantation. Late biliary tract complications occurring after T-tube r emoval mostly include stones and strictures which may be associated with se psis and worsening of the liver function. Endoscopic retrograde cholangiopa ncreatography (ERCP) has a role in the diagnosis and therapy of these compl ications. The aim of our study was to report our experience of endoscopic d iagnosis and treatment of late biliary tract complications in liver-transpl anted patients. Methods and Results: One hundred and thirty-six adult liver-transplanted pa tients have been followed since 1988. Seventeen patients (12.5%) needed a t otal of 30 ERCP because of evidence of clinical and/or biochemical cholesta ses: eight with biliary stricture; six with biliary stones; one with both s tricture and stones; and two with normal ERCP findings. Interventional endo scopic procedures included 14 sphincterotomies, six stone removals, seven b iliary balloon dilatations, seven biliary stent placements, 11 biliary sten t replacements, seven nasobiliary catheter placements and one mechanical li thotripsy. No complications were seen. In all cases, ERCP was able to ident ify the location, entity and dimension of the late biliary tract complicati on, thus allowing a therapeutic strategy to be used. Two patients had medic al cholestasis. Forty-seven per cent of patients with late biliary tract co mplications could definitely be cured by ERCP alone. The ERCP improved the patients' condition to allow subsequent surgery in five patients (33%). Conclusions: These results confirms that ERCP is a valuable diagnostic tool and should be considered as the first step in the non-surgical management of late biliary tract complications after orthotopic liver transplantation. (C) 2000 Blackwell Science Asia Pty Ltd.