Endoscopic management of biliary leaks after T-tube removal in liver transplant recipients: Nasobiliary drainage versus biliary stenting

This study presents the long-term sequelae of endoscopic retrograde cholang iopancreatography (ERCP)-managed biliary leakage in patients who underwent orthotopic liver transplantation (OLT) and compares the relative efficacy, safety, and charges of nasobiliary drainage (NBD) versus biliary stenting ( BS). We identified all orthotopic liver transplant recipients from January 1, 1993, to December 31, 1997, who had undergone ERCP for biliary leakage. Clinical outcome and charges were calculated on an intention-to-treat basis according to initial endoscopic therapy. Of the 1,166 adult OLTs performed during the study period, 442 patients underwent elective T-tube removal. E RCP was attempted in 69 patients (16%) who developed biliary leakage after T-tube removal. Three patients (5%) in whom initial ERCP was unsuccessful u nderwent surgery. NBD and BS were used as primary therapy in 45 (68%) and 2 1 patients (32%), respectively. Three patients initially treated with NBD r equired reendoscopy or surgery compared with 6 patients initially treated w ith BS (P < .05). Although not statistically significant, there was a trend toward greater expense in the BS group compared with the NBD group. ERCP i s a safe and effective method of managing biliary leakage after T-tube remo val in orthotopic liver transplant recipients. However, our results suggest NBD is the preferred method because recurrent leaks were more common in pa tients treated initially with BS. With prompt use of ERCP, surgery is rarel y needed for this complication of OLT.