7164 Endoscopic sphincterotomy is safe and well tolerated in orthotopic liver transplantation (olt) patients.

Abstract

Introduction Biliary complications such as bile leak (BL) and anastomotic strictures (AS) occurs in 15-20% of patients undergoing orthotopic liver transplant(OLT), and can be treated successfully by endoscopic techniques of stent placement and dilation, respectively. Endoscopic sphincterotomy (ES) is commonly performed during therapeutic endoscopic retrograde cholangiopancreatography (ERCP) to facilitate repeated cannulation and stent placement. Given concerns for bacterial contamination and stasis at the anastomotic site, some endoscopists avoid ES in these immunocompromised patients. Aim To determine the safety and clinical outcome of ES in OLT patients(“ES Group”) and to compare their course to OLT patients who underwent ERCP without ES (“No ES Group”) Methods Patients who received OLT between 1994-98 and required ERCP were included in the study. Patient demographics, ERCP indications, complications and post- ERCP course were analyzed. Complications of ERCP were catagorized as procedure-related and delayed(=30 days). Late adverse events recorded were related to biliary tract disease. Results Twenty-seven post OLT patients(17M, 10F, mean age 49 yrs, range 31-68) who required ERCP were studied. Mean follow up was 30 mos. in the ES group, and 35 mos. in the No ES group. ERCP indications, complications and clinical course are noted in the table below. Most (14/15) patients in the ES group underwent multiple ERCPs with stents and dilation for AS as per our protocol. Delayed ERCP complications occurred in 3 of 15 in the ES group(20%); all 3 had stones or sludge which predated ERCP/ES. The 3 patients who suffered late adverse events had recurrence of AS without new stones or sludge. No deaths were attributable to ES. Conclusion Endoscopic sphincterotomy in orthotopic liver transplant patients undergoing ERCP is safe, with a complication rate comparable to published data for non-OLT patients. Delayed complications and late adverse events (Stent occlusion, restenosis, death) in these patients appear to be unrelated to sphincterotomy per se, but common to all OLT patients.