Role of ERCP in Patients with Pancreatico-Biliary (PB) Disease in the Setting of Hematopoietic Stem Cell Transplant (HSCT)

Abstract

Background: Patients (pts) undergoing HSCT may develop PB complications that may need to be evaluated by ERCP. These pts are immunocompromised and may be at higher risk of procedure related complication than average risk pts. Surprisingly, few data have been published regarding ERCP findings/benefits/risks in this population. Aim: To determine the role of ERCP in the diagnosis, treatment, and outcome ERCP in the setting of HSCT. Materials &Methods: Retrospective analysis of HSCT pts who underwent ERCP from 1997-2004. We examined ERCP indications, diagnosis, therapeutic interventions, and complication rates. Results: Of the pts who received HSCT, 16 pts (7M/9F) were identified who had undergone ERCP; 15/16 had allogeneic HSCT & 1/16 had autologous HSCT. Indications for HSCT were: AML (6),CML (3), ALL (1), NHL (2), myeloma (1), met breast ca (2). 26 ERCP procedures were performed in these 16 pts. 10/16 pts were >100days post HSCT. 8/26 had a platelet count< 50x103/L. ERCP indications: obstructive jaundice (4); possible ascending cholangitis (7); post cholecystectomy bile leak (1); relapsing pancreatitis (4).ERCP Findings were: BD lithiasis (7), Ampullary infiltration from GVHD (3), BD stricture(1), BD leak (1),cholangitis (1), Mirrizzi (1), PD stone (1), normal (1). ERCP interventions were: BD sphincterotomy (8), BD lithiasis removal (11), BD stents (13), NB tube(4), PD stent for drainage(1), prophylactic temporary PD mini stents (6), Transpapillary endoscopic GB drain (2). Complications occurred in 3 pts: bleed (1), cholangitis due to late stent occlusion (1), mild pancreatits (1). No deaths. Conclusion: In patients with HSCT, BD lithiasis was the most common finding at ERCP, followed by obstructive ampullary tissue infiltration due to GVHD. ERCP was safe and successful in this population. Background: Patients (pts) undergoing HSCT may develop PB complications that may need to be evaluated by ERCP. These pts are immunocompromised and may be at higher risk of procedure related complication than average risk pts. Surprisingly, few data have been published regarding ERCP findings/benefits/risks in this population. Aim: To determine the role of ERCP in the diagnosis, treatment, and outcome ERCP in the setting of HSCT. Materials &Methods: Retrospective analysis of HSCT pts who underwent ERCP from 1997-2004. We examined ERCP indications, diagnosis, therapeutic interventions, and complication rates. Results: Of the pts who received HSCT, 16 pts (7M/9F) were identified who had undergone ERCP; 15/16 had allogeneic HSCT & 1/16 had autologous HSCT. Indications for HSCT were: AML (6),CML (3), ALL (1), NHL (2), myeloma (1), met breast ca (2). 26 ERCP procedures were performed in these 16 pts. 10/16 pts were >100days post HSCT. 8/26 had a platelet count< 50x103/L. ERCP indications: obstructive jaundice (4); possible ascending cholangitis (7); post cholecystectomy bile leak (1); relapsing pancreatitis (4).ERCP Findings were: BD lithiasis (7), Ampullary infiltration from GVHD (3), BD stricture(1), BD leak (1),cholangitis (1), Mirrizzi (1), PD stone (1), normal (1). ERCP interventions were: BD sphincterotomy (8), BD lithiasis removal (11), BD stents (13), NB tube(4), PD stent for drainage(1), prophylactic temporary PD mini stents (6), Transpapillary endoscopic GB drain (2). Complications occurred in 3 pts: bleed (1), cholangitis due to late stent occlusion (1), mild pancreatits (1). No deaths. Conclusion: In patients with HSCT, BD lithiasis was the most common finding at ERCP, followed by obstructive ampullary tissue infiltration due to GVHD. ERCP was safe and successful in this population.