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World J Gastroenterol. Jul 14, 2008; 14(26): 4185-4189
Published online Jul 14, 2008. doi: 10.3748/wjg.14.4185
Endoscopic treatment of biliary complications after liver transplantation
Ilaria Tarantino, Luca Barresi, Ioannis Petridis, Riccardo Volpes, Mario Traina, Bruno Gridelli
Ilaria Tarantino, Luca Barresi, Ioannis Petridis, Riccardo Volpes, Mario Traina, Department of Gastroenterology, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), University of Pittsburgh Medical Center (UPMC), Palermo 90100, Italy
Bruno Gridelli, Department of Surgery, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), University of Pittsburgh Medical Center, Palermo 90100, Italy
Author contributions: Tarantino I designed the study; Tarantino I and Barresi L wrote the study; Petridis I and Volpes R contributed data collection; Traina M and Gridelli B contributed analytic tools.
Correspondence to: Ilaria Tarantino, ISMETT/UPMC, via tricomi 1, Palermo 90100, Italy. itarantino@ismett.edu
Telephone: +39-335-7357728
Fax: +39-91-2192244
Received: February 26, 2008
Revised: June 17, 2008
Accepted: June 24, 2008
Published online: July 14, 2008
Abstract

AIM: To evaluate the efficacy of endoscopic treatment in patients who undergo OLTx or LRLTx and develop biliary complications.

METHODS: This is a prospective, observational study of patients who developed biliary complications, after OLTx and LRLTx, with duct-to-duct anastomosis performed between June 2003 and June 2007. Endoscopic Retrograde Cholangiopancreatography (ERCP) was considered unsuccessful when there was evidence of continuous bile leakage despite endoscopic stent placement, or persistence of stenosis after 1 year, despite multiple dilatation and stent placement. When the ERCP failed, a percutaneous trans-hepatic approach (PTC) or surgery was adopted.

RESULTS: From June 2003 to June 2007, 261 adult patients were transplanted in our institute, 68 from living donors and 193 from cadaveric donors. In the OLTx group the rate of complications was 37.3%, while in the LRLTx group was 64.7%. The rate of ERCP failure was 19.4% in the OLTx group and 38.6% in LRLTx group. In OLTx group, 1 patient was re-transplanted and 8 patients died. In the LRLTx group, 2 patients underwent OLTx and 8 patients died. The follow-up was 23.3 ± 13.13 mo and 21.02 ± 14.10 mo, respectively.

CONCLUSION: Although ERCP is quite an effective mode of managing post-transplant bile duct complications, a significant number of patients need other types of approach. Further prospective studies are necessary in order to establish whether other endoscopic protocols or new devices, could improve the current results.

Keywords: Endoscopic retrograde cholangiopancreatography; Biliary complication; Liver transplant; Benign stenosis; Biliary leak