Application value of ERCP in biliary stricture following liver transplantation

Abstract

Objective To investigate the application value of endoscopic retrograde cholangiopancreatography (ERCP) in biliary stricture following liver transplantation (LT). Methods Clinical data of 47 patients with biliary stricture following LT treated with ERCP in the Third Affiliated Hospital of Sun Yat-sen University between January 2008 and January 2014 were retrospectively studied. The informed consents of all patients were obtained and the local ethical committee approval had been received. Among the 47 patients, 41 were males and 6 were females with the age ranging from 24 to 62 years old and the median of 51 years old. Anastomotic stricture was observed in 31 cases and non-anastomotic stricture in 16 cases. ERCP was performed on patients to localize biliary stricture and then papillotomy was performed under the support of guide wire. The stricture was dilated progressively by dilating catheter or columnar balloon through the guide wire. Endoscopic nasobiliary drainage or plastic stent placement was chosen according to the ERCP results. The evaluation of curative effect was graded by cure, improvement, inefficacy and restenosis. Results All the 47 patients underwent ERCP successfully with totally 112 times. Nasobiliary drainage was performed 79 person-times, stent placement 33 person-times. Among the 31 patients with anastomtic stricture, 28 were cured and 3 were improved. Among the 16 patients with non-anastomtic stricture, 5 were cured, 3 were improved, and 8 were ineffective. The total cured rate of all the patients was 70% (33/47) and the effective rate was 83% (39/47). The incidence of complications was 9% (4/47), including 2 cases of mild pancreatitis, 1 case of hyperamylasemia and 1 case of biliary tract infection. Conclusion ERCP is safe, effective and integrated in diagnosis and treatment for biliary stricture following LT, which is the first choice for non-surgery treatment. Key words: Liver transplantation; Biliary complication; Cholangiopancreatography, endoscopic retrograde