Hepatobiliary Dysfunction Research Articles

HLA, GVHD, and parenteral nutrition are risk factors for hepatic complications in pediatric HSCT.

Hepatic dysfunction is common after allogeneic hematopoietic stem cell transplantation (HSCT). The aim of this retrospective study was to determine the risk factors, frequency, and outcome of hepatic complications post-HSCT in children. Two hundred and thirty-seven cases of allogeneic HSCT in children were included. Data on biochemical liver function at start of HSCT, at +1, +3, +6, and +9 months, and at each subsequent yearly follow-up were extracted. Patients were stratified into groups with hepatocellular (none and mild, and moderate to severe) and hepatobiliary (none and present) dysfunction. Statistical analysis included variables such as diagnosis, age, conditioning regimen, and HLA type. One hundred and fifty-six (66%) patients displayed hepatocellular dysfunction post-HSCT. In most cases transient, but 32% had a persistent abnormality three yr post-HSCT. Risk factors were chronic GVHD (OR 4.20, p = 0.003) and donor HLA-A*01 (OR 2.97, p = 0.02). HLA-DQB1*03 decreased the risk (OR 0.35, p = 0.02). Hepatobiliary dysfunction was less frequent (12%) but carried a poor prognosis. aGVHD grade II-IV (OR 2.7, p = 0.02) and long-term TPN (OR 3.25, p = 0.01) increased the risk. GVHD is an important risk factor for liver dysfunction post-HSCT. Specific HLA types may also contribute as a risk factor, while others seem to have a protective effect.

Fatal cryptococcosis presenting as hepatobiliary dysfunction in an ALL patient

Although current therapies for acute lymphoblastic leukemia (ALL) in children provide high cure rates, invasive fungal infections remain a significant source of mortality. We report a fatal case of cryptococcosis presenting as hepatic dysfunction in a patient with ALL and Down syndrome. Autopsy results confirmed Cryptococcus septicemia with involvement of lungs, liver, and lymph nodes. The severity of the fungal sepsis and underlying immunosuppression probably contributed to the unusual presentation and fatal outcome. This report highlights the need to consider cryptococcal infection as a cause of sepsis syndrome in immunocompromised patients when bacterial cultures are negative.

Assessment of γ-GT functions as novel risk factor in patients suffering from angina, myocardial infarction and congestive heart failure

BackgroundCardiovascular disease is a leading cause of morbidity and mortality both in developed and developing country. The spectrum of cardiac diseases starting from hypertension to acute coronary syndrome is interplay of a number of modifiable and non-modifiable risk factors. Free radicals triggering oxidative events influence atherosclerotic plaque formation and thereby, initiate the vicious cycle of cardiovascular mortality. Traditionally, GGT (gamma glutamyl transferase) is used as marker of hepatobiliary dysfunction and alcohol intake. With the advent of biomedical science the last decade has seen the development in the physiological role of γ-GT related to oxidative stress. GGT is established as novel, low-cost, sensitive laboratory marker in the definition of risk factor for coronary heart disease and ischeamia in Australian, Norwegian population. ObjectivesThe objective of this study was to estimate the serum concentration of GGT in patients suffering from myocardial infarction, angina and congestive heart failure and to see its association with cardiovascular mortality. MethodIn this cross-sectional study serum GGT concentration was estimated in patients of myocardial infarction, angina and congestive heart failure and compared with control group. All the study subjects were evaluated with ECG and Echocardiography for cardiac changes. Statistical analysis was performed using SPSS 16 to see whether GGT is increased in cases and associated with the risk factors. ResultsThe serum concentration of GGT was significantly higher in cases. There was significant association with the established risk factors. ConclusionGGT is associated with risk factors of cardiovascular disease.

Multiorgan Dysfunction Related to Chronic Ketamine Abuse

Ketamine abuse is being increasingly reported worldwide. The drug can produce a dissociative state and hallucinations, making ketamine a favorite recreational agent among drug addicts. Chronic ketamine abuse can damage many organs, including the brain, heart, liver, gastrointestinal tract, and genitourinary system. We report a patient with chronic ketamine abuse who presented with severe cachexia, upper gastrointestinal involvement, hepatobiliary dysfunction, and acute kidney injury.

Renal and hepatobiliary dysfunction in chronic obstructive pulmonary disease

This review examines the associations between chronic obstructive pulmonary disease (COPD) and renal and hepatobiliary diseases, with emphasis on the epidemiology and clinical outcomes, along with current information on pathophysiologic mechanisms and risk factors. Glomerular filtration, sodium retention, and waste excretion are abnormal in COPD and sensitive to hypoxemia and hypercarbia, but variably responsive to oxygen administration and angiotensin-converting enzyme inhibition. Newer concepts about the role of hypoxia on the progression of chronic renal failure, and improved understanding about the relationships between COPD, decreased arterial compliance, and renal glomerular injury, are bringing new insights about potential causal mechanisms between COPD and kidney diseases. Other than the well known relationship between cor pulmonale and passive liver congestion, little was known about the relationships between COPD and liver diseases until recent population-based surveys demonstrated that COPD patients have substantially elevated risk for specific hepatobiliary system diseases. Renal complications of COPD are common especially among patients with hypoxemia and hypercarbia. Renal-endocrine mechanisms, tissue hypoxia, and vascular rigidity have roles in the pathophysiology, but understanding of causal relationships is not precise. COPD patients have increased risk for hepatobiliary diseases and asymptomatic elevations of hepatic transaminases, which fortunately have relatively low prevalence.

New phytoconstituents from the aerial parts of Fumaria parviflora Lam.

Fumaria parviflora Lam. (Fumariaceae) is an annual herb found throughout the world. Traditionally it has great significance in various disorders. In folk medicine of Turkey it is used against hepato-biliary dysfunction and imported from Iran. In Charaka and Sushruta, it is recommended for treatment of fevers, blood disorders, chronic skin diseases, urinary diseases and cough. The compounds were isolated from methanolic extract of the plants by column chromatography using silica gel (60-120 mesh) as stationary phase and structure of the isolated compounds have been established on the basis of spectral data analysis and chemical reactions. Phytochemical investigation of its aerial parts led to the isolation of five new compounds characterized as (5αH,11αH)-8-oxo-homoiridolide (1), n-docosanyl-2-O-β-D-glucopyranosyl salicylate (2), 2-methyl-6-hydroxymethylenedodecan-10-oyl-12, 15-olide14-O-β-D-xylopyranoside (3), 4-oxo-stigmast-5-en-3β-ol-D-glucopyranoside (4) and salicylic acid-O-β-D-xylopyranoside (5) along with the known compounds α-D-glucopyranosyl hexadecanoate (6) and α-D-glucopyranosyl- (2 → 1ʹ)-α-D-glucopyranoside (7). The isolated compounds are useful as they will provide essential data and information for the further researchers and development of effective analytical marker for identity, purity and quality control of this traditional plant in future.

Correction of the functional condition of the bile excretory system in pathogenetic management of polymorbid patients with atherosclerosis

The aim of the search was development of some methods for improvement of effectiveness of treatment of polymorbid patients with atherosclerosis and disordered bile outflow. Complex phytotherapy (phytocomplex «Hepar») with its hepatoprotective and choleratic effects was prescribed for 33 patients with atherosclerosis and hepatobiliary dysfunction (in addition to dietotherapy and choleratics). Administration of the balanced phytotherapy resulted in significant reduction of the cholesterol level associated with the decrease of the C-reactive protein index in the blood. These changes were followed by decrease of the blood lipids and protein substrates oxidation - the factors meaning suppression of the degree of oxidative stress and of inflammation in the body.

Peculiarities Of Hepatobiliary System Functioning Depending On The Severity Of Preeclampsia

The article presents results of peculiarities of the hepatobiliary system in pregnant women with preeclampsia. It is set in the pregnant with preeclampsia of mild severity the frequency and combination of two and more complaints was reliably lower comparing to the frequency and combination of complaints in the pregnant with preeclampsia of mean severity. It must be mentioned that the received laboratory data positively correlated with the clinical manifestations of hepatobiliary dysfunction and the level of severity of preeclampsia that makes the further scientific researches necessary in future. Among the ultrasound signs of the dysfunction of the hepatobiliary system the following were detected: hepatomegaly, diffuse changes in the liver, increasing the density of the gallbladder against the decrease in contractility of the formation of sludge.

Neonatal Cholestasis

Cholestatic jaundice is a common presenting feature of neonatal hepatobiliary and metabolic dysfunction. Any infant who remains jaundiced beyond age 2 to 3 weeks should have the serum bilirubin level fractionated into a conjugated (direct) and unconjugated (indirect) portion. Conjugated hyperbilirubinemia is never physiologic or normal. The differential diagnosis of cholestasis is extensive, and a step-wise approach based on the initial history and physical examination is useful to rapidly identify the underlying etiology. Early recognition of neonatal cholestasis is essential to ensure timely treatment and optimal prognosis. Even when specific treatment is not available, infants who have cholestasis benefit from early medical management and optimization of nutrition. Future studies are necessary to determine the most reliable and cost-effective method of universal screening for neonatal cholestasis.

Neonatal Cholestasis in Gram‐negative Septicaemia

To the Editor: We read the study of Khalil et al (1) about hepatobiliary dysfunction in neonatal septicaemia with a high interest. They reported cholestatic jaundice with a rate of 42.5% in Gram-negative septicaemia. We retrospectively reviewed our 5-year (2006–2011) data of neonates with Gram-negative septicaemia. Seventy of 92 infants with Gram-negative confirmed sepsis were included in the study. The remaining were excluded because of comorbitidities associated with cholestasis. The responsible pathogens were determined as Escherichia coli (n = 22), Klebsiella pneumoniae (n = 18), Klebsiella oxytoca (n = 7), Pseudomonas aeruginosa, (n = 8), Serratia marcescens (n = 4), and Acinetobacter baumannii (n = 11). Mean gestational age was 33.5 weeks (25.9–40.2) with a mean birth weight 2085 g (560–4500). A total of 26 (37.1%) infants did not survive to discharge. Cholestasis (direct bilirubin >20% of total with a minimum level of 2 mg/dL) was present in 18 (25.7%) infants with a median 7 days (2–90) of gestational age. The prevalence of cholestasis was comparable between survivors and nonsurvivors (23% vs 27.2%, P > 0.05). Mean conjugated bilirubin level was 1.5 ± 2.5 mg/dL and 1.2 ± 1.8 mg/dL in survivors and nonsurvivors, respectively (P > 0.05); however, mean total bilirubin level was significantly higher in survivors as compared with nonsurvivors (12.1 ± 10 mg/dL vs 7.5 ± 4 mg/dL, P = 0.001). As the nature of the retrospective study, the time of bilirubin obtaining is not identical; however, median total and direct bilirubin sampling times were similar in survivors and deaths (6 days vs 7 days, P > 0.05) in the present study. Bilirubin levels and liver function tests were normal, 3 months after the onset of cholestasis in all of the infants. Our results support previous reports that neonatal cholestasis caused by Gram-negative sepsis is frequent, mild, transient (1,2), and has an early onset (1,3). Cholestasis and the level of conjugated bilirubin did not influence the prognosis, which is in contrast with Khalil et al (1), whereas higher total bilirubin levels are associated with a higher rate of the survival in our study. We support the hypothesis that bilirubin has a beneficial effect on the prognosis of Gram-negative sepsis.

Вивчення активності гепатоцелюлярних маркерів сироватки крові у дітей, які проживають в екологічно несприятливому районі

Проведений аналіз результатів клінічного обстеження та активності гепатоцелюлярних маркерів сироватки крові для ранньої діагностики ушкодження печінки у дітей, які проживають на території з комбінованим хімічним та радіоактивним забрудненням. Виявлено, що екопатологія в обстежених дітей має полісистемний характер, проявляючись синдромами дезадаптації, провідними з яких є гепатобіліарна патологія, патологія нирок та щитоподібної залози. Доведено, що сорбітолдегідрогеназа є більш чутливим та більш специфічним маркером діагностики ушкодження клітин печінки у дітей, які проживають в екологічно несприятливому регіоні, ніж трансамінази сироватки крові.

A 42–Year–Old Woman With a New Diagnosis of Sclerosing Cholangitis

A 42-year-old woman is referred to you for severe pruritus, dark urine, and acholic stools. These symptoms have gradually increased during the past 7–10 days. She had previously been in good health with no history of hepatobiliary dysfunction. She complains of right upper quadrant discomfort and a general sense of malaise. Blood tests reveal a normal complete blood count, but her liver enzymes are elevated in a cholestatic pattern. Her alkaline phosphatase level is approximately 3 times the upper limit of normal (ULN) at 428 U/L, the aspartate aminotransferase level is 1.5 times the ULN at 116 U/L, and the total serum bilirubin is 6.4 mg/dL, with a direct bilirubin of 4.8 mg/dL.

Prevalence and Outcome of Hepatobiliary Dysfunction in Neonatal Septicaemia

Cholestatic jaundice and liver enzyme abnormalities have been reported in neonatal septicaemia; the course, pattern, and outcome of such hepatobiliary dysfunction have not been described. One hundred fifty-three neonates with blood culture-positive sepsis were recruited from the neonatal intensive care unit of an urban hospital. Liver function tests were done on day 3 and day 10 in all of the cases. In babies with abnormal results (direct bilirubin >20% of total with a minimum level of 2/dL or alanine aminotransferase [ALT] >50 U/L), tests were repeated weekly for 1 month and then fortnightly for 3 months or until normalization of values. Anthropometry was recorded at all of these visits. Klebsiella pneumoniae was the commonest organism, isolated in 95.4% of subjects. Eighty-three (54.2%) subjects had hepatobiliary dysfunction in the form of either cholestatic jaundice (n = 65 [42.5%]) or derangement in ALT (n = 57 [37.3%]). The onset of cholestasis was seen by day 3 of sepsis in 80% (n = 52), with maximum value of direct bilirubin seen by the 10th day in 90% (n = 58). Only 15% (n = 10) continued to have cholestatic jaundice beyond 30 days of onset of sepsis, and it resolved by 60 days. Hepatic enzyme abnormalities followed a more protracted course: onset by day 10 in 95%, peak value by day 38 in 90%, and normalisation by 60 days in 82% of subjects. The prevalence of any hepatobiliary dysfunction was found less frequently in babies who died as compared with survivors (43.4% vs 56.7%; P < 0.01). The weight, length, and head circumference during follow-up visits were comparable between neonates with or without hepatobiliary dysfunction. Hepatobiliary dysfunction is common in Gram-negative neonatal septicaemia. The onset of abnormalities is early in most cases but ultimately resolve within 2 to 3 months after sepsis. The presence of conjugated hyperbilirubinemia in neonatal sepsis may carry a better prognosis in terms of survival and has no significant effect on growth during early infancy.

Metabolic Profiling of the Rat Liver After Chronic Ingestion of Alpha-Naphthylisothiocyanate Using In Vivo and Ex Vivo Magnetic Resonance Spectroscopy

Certain human diseases affecting the biliary tree can be modeled in rats by ingestion of the hepatobiliary toxin alpha-naphthylisothiocyanate (ANIT). Phosphorus magnetic resonance spectroscopy (MRS) allows the noninvasive monitoring of cell dynamics through detection of phosphodiesters (PDE) and phosphomonoesters (PME). Hepatic (31)P MRS techniques were therefore used to study the toxic effects of low-dose chronic ANIT ingestion, with a view toward providing biomarkers sensitive to hepatobiliary dysfunction and cholestatic liver injury. Rats were fed an ANIT supplemented diet at three doses (ANIT_0.05%, ANIT_0.04%, and ANIT_0.025%) for 2 weeks. Data from in vivo MRS were compared with results from pair-fed controls (PFCs). Blood and tissue samples were collected at 2 weeks for clinical chemistry, histology, and (1)H magic angle spinning MRS. Increases in PDE, relative to total phosphorus (tPh), were detected in both the ANIT_0.05% and ANIT_0.04% groups (0.07 ± 0.01 and 0.08 ± 0.01, respectively) relative to PFC groups (0.03 ± 0.01 and 0.05 ± 0.01, respectively). An increase in PME/tPh was observed in the ANIT_0.05% group only (0.17 ± 0.02) relative to PFC_0.05% (0.12 ± 0.01). Ex vivo (1)H MRS findings supported this, wherein measured phosphocholines (PCs) were increased in ANIT_0.05% and ANIT_0.04% groups. Increases in relative total choline (tCho) distinguished the ANIT_0.05% group from the ANIT_0.04% group. Markers of hepatotoxicity such as raised total bilirubin and alkaline phosphatase were found at all ANIT doses. Histological findings included a dose-related increase in both severity of biliary hyperplasia and focal hepatocellular necrosis. Here, we found that ANIT-induced moderate hepatobiliary dysfunction was associated with a relative increase in phosphodiesters in vivo and PCs ex vivo. Raised PME/tPh in vivo and tCho ex vivo were also present at high doses corresponding to a higher incidence of marked biliary hyperplasia and moderate hepatocellular necrosis.

The effect of adding fish oil to parenteral nutrition on hepatic mononuclear cell function and survival after intraportal bacterial challenge in mice

Parenteral nutrition (PN) is indispensable for meeting caloric and substrate needs of patients who cannot receive adequate amounts of enteral nutrition; however, PN impairs hepatic immunity. We examined the effects of ω-3 and -6 polyunsaturated fatty acids, added individually to fat-free PN, on hepatic immunity in a murine model. We focused on serum liver enzymes, cytokine production, histopathology, and the outcomes after intraportal bacterial challenge. Male Institute of Cancer Research mice were randomized into 4 groups; ad libitum chow (CHOW), fat-free PN (FF-PN), PN + fish oil (FO-PN), or PN + safflower oil (SO-PN). After the mice had been fed for 5 days, hepatic mononuclear cells (MNCs) were isolated. The number of MNCs was counted and cytokine production (tumor necrosis factor [TNF]-α and interleukin [IL]-10) by hepatic MNCs in response to lipopolysaccharide (LPS) was measured. Blood samples were analyzed for hepatobiliary biochemical parameters. Moreover, 1.0 × 10(7) pseudomonas aeruginosa were delivered by intraportal injection. Survival and histology were examined. Hepatic MNC numbers were significantly less in the FO-PN and FF-PN than in the CHOW group, whereas the SO-PN group showed moderate recovery of hepatic MNC numbers. The CHOW, FO-PN, and SO-PN groups showed LPS dose-dependent increases in TNF-α levels. These increases were blunted in the FF-PN group. IL-10 levels were increased LPS dose-dependently in the CHOW and FO-PN groups, but no marked changes were observed with LPS stimulation in the SO-PN and FF-PN groups. Plasma levels of aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase were significantly greater in the FF-PN than in the FO- and SO-PN and CHOW groups. The FO-PN group showed significantly improved survival compared with the SO-PN and FF-PN groups, showing essentially no morphologic hepatic abnormalities. Addition of fish oil to PN was advantageous in terms of reversing PN-induced deterioration of hepatic immunity, as reflected by altered cytokine production. Fish oil administration was also useful for preventing PN-induced hepatobiliary dysfunction. These changes seem to result in better survival and to protect against severe tissue damage after intraportal bacterial challenge. This therapy may have the potential to ameliorate PN-induced impairment of host immunity and thereby decrease morbidity and mortality.

New aspects in the clinical spectrum of neonatal lupus

Neonatal lupus erythematosus (NLE) is a rare, passively acquired autoimmune disease, caused by maternal autoantibodies. Characteristic clinical features of NLE are transient rash and congenital heart block (CHB), but also hematological abnormalities and hepatobiliary dysfunction may occur. Complications to the transient dermatitis are rarely described. We describe two patients with NLE and cutaneous manifestations. Both patients had involvement of the sun-protected genital skin and soles. New manifestations of NLE were gastrointestinal bleeding in one patient despite normal coagulation parameters, but with mucosal telangiectatic lesions found on sigmoidoscopy. In addition, one patient developed painful atrophy after plantar dermatitis on follow-up with need of orthopedic footwear. CHB was not found. In conclusion, NLE may be complicated with sigmoidal telangiectasia with rectal bleeding and painful plantar atrophy.

Quantifying differences in hepatic uptake of the liver specific contrast agents Gd-EOB-DTPA and Gd-BOPTA: a pilot study

To develop and evaluate a procedure for quantifying the hepatocyte-specific uptake of Gd-BOPTA and Gd-EOB-DTPA using dynamic contrast-enhanced (DCE) MRI. Ten healthy volunteers were prospectively recruited and 21 patients with suspected hepatobiliary disease were retrospectively evaluated. All subjects were examined with DCE-MRI using 0.025 mmol/kg of Gd-EOB-DTPA. The healthy volunteers underwent an additional examination using 0.05 mmol/kg of Gd-BOPTA. The signal intensities (SI) of liver and spleen parenchyma were obtained from unenhanced and enhanced acquisitions. Using pharmacokinetic models of the liver and spleen, and an SI rescaling procedure, a hepatic uptake rate, K (Hep), estimate was derived. The K (Hep) values for Gd-EOB-DTPA were then studied in relation to those for Gd-BOPTA and to a clinical classification of the patient's hepatobiliary dysfunction. K (Hep) estimated using Gd-EOB-DTPA showed a significant Pearson correlation with K (Hep) estimated using Gd-BOPTA (r = 0.64; P < 0.05) in healthy subjects. Patients with impaired hepatobiliary function had significantly lower K (Hep) than patients with normal hepatobiliary function (K (Hep) = 0.09 ± 0.05 min(-1) versus K (Hep) = 0.24 ± 0.10 min(-1); P < 0.01). A new procedure for quantifying the hepatocyte-specific uptake of T (1)-enhancing contrast agent was demonstrated and used to show that impaired hepatobiliary function severely influences the hepatic uptake of Gd-EOB-DTPA. • The liver uptake of contrast agents may be measured with standard clinical MRI. • Calculation of liver contrast agent uptake is improved by considering splenic uptake. • Liver function affects the uptake of the liver-specific contrast agent Gd-EOB-DTPA. • Hepatic uptake of two contrast agents (Gd-EOB-DTPA, Gd-BOPTA) is correlated in healthy individuals. • This method can be useful for determining liver function, e.g. before hepatic surgery.

P103 Metabolic profiling of the rat liver after chronic ingestion of α-naphthylisothiocyanate using in vivo and ex vivo magnetic resonance spectroscopy

IntroductionHepatobiliary injury, associated with intrahepatic cholestasis and biliary hyperplasia, is a commonly encountered adverse effect in man in response to certain drugs and toxins. Some human diseases affecting the biliary...

Safety of Low-Dose Oral Dantrolene Sodium on Hepatic Function

Kim JY, Chun S, Bang MS, Shin H-I, Lee S-U. Safety of low-dose oral dantrolene sodium on hepatic function. Objective To investigate the incidence of hepatobiliary dysfunction after administration of low-dose dantrolene sodium. Design A retrospective survey of medical records. Setting One secondary and 2 tertiary hospitals. Participants Patients (N=243; 144 men, 27 children; mean age ± SD, 47.8±19.7y) who were administered dantrolene at a daily dose of 12.5 to 400mg for more than 4 weeks. Interventions Not applicable. Main Outcome Measures Liver function test (LFT) results, including serum total bilirubin, aspartate transaminase, alanine transaminase, and alkaline phosphatase, were recorded before and at least 1 month after the initial dose of dantrolene. In cases of treatment cessation, the reason was investigated. Significantly elevated LFT levels were defined as ≥ to 2 times the upper limit of the normal range. Results Treatment duration was 268.0±428.5 days with a daily dose of 65.2±44.7mg. At the end of the investigation, 95 patients (39.1%) had been lost to follow-up, and 105 (43.2%) had stopped treatment. The reasons for cessation were improved spasticity (42.9%), no effect of the medication (27.6%), weakness (6.7%), and other medical problems (5.7%). Patients with weaknesses did not have elevated LFT values. A 32-year-old man with head injuries and multiple trauma developed hepatic dysfunction 82 days after the initial dose and 43 days after a dose increment to 400mg/d. Other patients did not experience significant LFT abnormalities. Conclusions One case of hepatic dysfunction was recorded in 243 cases after at least 4 weeks of low-dose oral dantrolene administration. Low-dose dantrolene can be used safely with meticulous clinical and laboratory monitoring.

Role of ERCP in patients after hematopoietic stem cell transplantation

The role of ERCP in evaluating patients with hepatobiliary dysfunction after hematopoietic stem cell transplantation (HSCT) has not been well-defined. The aim of this study was to better define the role of ERCP after HSCT by reviewing our institutional experience, including indications, findings, and outcomes. Retrospective review of ERCP findings and outcomes in patients after HSCT. MD Anderson Cancer Center from 1997 to 2009. A total of 40 patients had ERCP after HSCT during the study period. ERCP. Overall survival. A total of 40 patients had ERCP after HSCT during the study period. Seventeen patients had biliary strictures (group 1), and 13 proved to be malignant. Ten patients had common duct stones (group 2). Thirteen patients (group 3) had neither stones nor stricture. Findings in group 3 included bile duct leak (1), dilation without stricture (2), resolution of pretransplant strictures (3), biliary sludge (1), or normal ducts (6). The normal subset proved to have hepatic graft-versus-host disease (GVHD) (3), hepatic drug toxicity (1), hepatic recurrence of myeloma (1), or pancreatitis with biliary sludge (1). Patients with GI GVHD were equally distributed among the 3 groups. Group 1 had 100% mortality with median time to death being 85 days after ERCP. Group 2 had 30% mortality with median time to death of 584 days after ERCP. Ten of 13 patients in Group 3 died at a median of 148 days after ERCP. The only procedural complication was a mild case of pancreatitis. Retrospective study at a single center. One in every 130 post-HSCT patients required ERCP evaluation. Biliary stricture is frequently caused by recurrent or new malignancy, particularly after autologous HSCT. GI GVHD is not associated with biliary stricture. ERCP procedural risks in HSCT patients are acceptable.