Safety and efficacy of endoscopic retrograde cholangiopancreatography in patients with post-liver transplant biliary complications: Results of a cohort study with long-term follow-up

Claudia Sanna, Chiara Giordanino, Ilaria Giono, Claudio Barletti, Arnaldo Ferrari, Serafino Recchia, Dario Reggio, Alessandro Repici, Alessandro Ricchiuti, Mauro Salizzoni, Ileana Baldi, Giovannino Ciccone, Mario Rizzetto, Giorgio Saracco

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Abstract

Background/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is the standard approach for the management of biliary complications in liver transplant patients; however, its safety and efficacy have not been established in this setting. This study was performed to evaluate the safety and long-term efficacy of ERCP in transplant patients. Methods: The case reports of 1,500 liver transplant patients were reviewed. Orthotopic liver transplantation (OLT) patients were matched 1:2 with non-OLT patients and followed-up for long-term outcome (median, 7.4 years). Results: Of the 1,500 liver transplant patients, 94 (6.3%) underwent 150 ERCPs after OLT. Anastomotic strictures were present in 45 patients, biliary stones in 24, biliary leaks in 7, papillary stenosis in 2, and primary sclerosing cholangitis in 1. An ERCP success rate of 90.7% was achieved; biliary stenting led to resolution of the bile leak in 7/7 (100%) patients, and biliary stones were removed in 21/24 (87.5%) patients. In addition, 34 of 45 patients with anastomotic stricture underwent endoscopic dilation. We obtained complete resolution in 22/34 (64.7%) patients. OLT patients did not show a higher probability of complications (odds ratio [OR], 1.04), of pancreatitis (OR, 0.80) or of bleeding (OR, 1.34). Conclusions: ERCP is safe and effective for the treatment of post-OLT biliary complications, has a low rate of pancreatitis and results in a durable effect.

Original languageEnglish
Pages (from-to)328-334
Number of pages7
JournalGut and Liver
Volume5
Issue number3
DOIs
Publication statusPublished - Sep 2011

Fingerprint

Endoscopic Retrograde Cholangiopancreatography
Cohort Studies
Transplants
Safety
Liver
Liver Transplantation
Pathologic Constriction
Odds Ratio
Pancreatitis
Sclerosing Cholangitis
Bile
Dilatation
Hemorrhage

Keywords

  • Biliary complications
  • Endoscopic retrograde cholangiopancreatography
  • Liver transplant
  • Pancreatitis

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Safety and efficacy of endoscopic retrograde cholangiopancreatography in patients with post-liver transplant biliary complications : Results of a cohort study with long-term follow-up. / Sanna, Claudia; Giordanino, Chiara; Giono, Ilaria; Barletti, Claudio; Ferrari, Arnaldo; Recchia, Serafino; Reggio, Dario; Repici, Alessandro; Ricchiuti, Alessandro; Salizzoni, Mauro; Baldi, Ileana; Ciccone, Giovannino; Rizzetto, Mario; Saracco, Giorgio.

In: Gut and Liver, Vol. 5, No. 3, 09.2011, p. 328-334.

Research output: Contribution to journalArticle

Sanna, C, Giordanino, C, Giono, I, Barletti, C, Ferrari, A, Recchia, S, Reggio, D, Repici, A, Ricchiuti, A, Salizzoni, M, Baldi, I, Ciccone, G, Rizzetto, M & Saracco, G 2011, 'Safety and efficacy of endoscopic retrograde cholangiopancreatography in patients with post-liver transplant biliary complications: Results of a cohort study with long-term follow-up', Gut and Liver, vol. 5, no. 3, pp. 328-334. https://doi.org/10.5009/gnl.2011.5.3.328
Sanna, Claudia ; Giordanino, Chiara ; Giono, Ilaria ; Barletti, Claudio ; Ferrari, Arnaldo ; Recchia, Serafino ; Reggio, Dario ; Repici, Alessandro ; Ricchiuti, Alessandro ; Salizzoni, Mauro ; Baldi, Ileana ; Ciccone, Giovannino ; Rizzetto, Mario ; Saracco, Giorgio. / Safety and efficacy of endoscopic retrograde cholangiopancreatography in patients with post-liver transplant biliary complications : Results of a cohort study with long-term follow-up. In: Gut and Liver. 2011 ; Vol. 5, No. 3. pp. 328-334.
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abstract = "Background/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is the standard approach for the management of biliary complications in liver transplant patients; however, its safety and efficacy have not been established in this setting. This study was performed to evaluate the safety and long-term efficacy of ERCP in transplant patients. Methods: The case reports of 1,500 liver transplant patients were reviewed. Orthotopic liver transplantation (OLT) patients were matched 1:2 with non-OLT patients and followed-up for long-term outcome (median, 7.4 years). Results: Of the 1,500 liver transplant patients, 94 (6.3{\%}) underwent 150 ERCPs after OLT. Anastomotic strictures were present in 45 patients, biliary stones in 24, biliary leaks in 7, papillary stenosis in 2, and primary sclerosing cholangitis in 1. An ERCP success rate of 90.7{\%} was achieved; biliary stenting led to resolution of the bile leak in 7/7 (100{\%}) patients, and biliary stones were removed in 21/24 (87.5{\%}) patients. In addition, 34 of 45 patients with anastomotic stricture underwent endoscopic dilation. We obtained complete resolution in 22/34 (64.7{\%}) patients. OLT patients did not show a higher probability of complications (odds ratio [OR], 1.04), of pancreatitis (OR, 0.80) or of bleeding (OR, 1.34). Conclusions: ERCP is safe and effective for the treatment of post-OLT biliary complications, has a low rate of pancreatitis and results in a durable effect.",
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T2 - Results of a cohort study with long-term follow-up

AU - Sanna, Claudia

AU - Giordanino, Chiara

AU - Giono, Ilaria

AU - Barletti, Claudio

AU - Ferrari, Arnaldo

AU - Recchia, Serafino

AU - Reggio, Dario

AU - Repici, Alessandro

AU - Ricchiuti, Alessandro

AU - Salizzoni, Mauro

AU - Baldi, Ileana

AU - Ciccone, Giovannino

AU - Rizzetto, Mario

AU - Saracco, Giorgio

PY - 2011/9

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N2 - Background/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is the standard approach for the management of biliary complications in liver transplant patients; however, its safety and efficacy have not been established in this setting. This study was performed to evaluate the safety and long-term efficacy of ERCP in transplant patients. Methods: The case reports of 1,500 liver transplant patients were reviewed. Orthotopic liver transplantation (OLT) patients were matched 1:2 with non-OLT patients and followed-up for long-term outcome (median, 7.4 years). Results: Of the 1,500 liver transplant patients, 94 (6.3%) underwent 150 ERCPs after OLT. Anastomotic strictures were present in 45 patients, biliary stones in 24, biliary leaks in 7, papillary stenosis in 2, and primary sclerosing cholangitis in 1. An ERCP success rate of 90.7% was achieved; biliary stenting led to resolution of the bile leak in 7/7 (100%) patients, and biliary stones were removed in 21/24 (87.5%) patients. In addition, 34 of 45 patients with anastomotic stricture underwent endoscopic dilation. We obtained complete resolution in 22/34 (64.7%) patients. OLT patients did not show a higher probability of complications (odds ratio [OR], 1.04), of pancreatitis (OR, 0.80) or of bleeding (OR, 1.34). Conclusions: ERCP is safe and effective for the treatment of post-OLT biliary complications, has a low rate of pancreatitis and results in a durable effect.

AB - Background/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is the standard approach for the management of biliary complications in liver transplant patients; however, its safety and efficacy have not been established in this setting. This study was performed to evaluate the safety and long-term efficacy of ERCP in transplant patients. Methods: The case reports of 1,500 liver transplant patients were reviewed. Orthotopic liver transplantation (OLT) patients were matched 1:2 with non-OLT patients and followed-up for long-term outcome (median, 7.4 years). Results: Of the 1,500 liver transplant patients, 94 (6.3%) underwent 150 ERCPs after OLT. Anastomotic strictures were present in 45 patients, biliary stones in 24, biliary leaks in 7, papillary stenosis in 2, and primary sclerosing cholangitis in 1. An ERCP success rate of 90.7% was achieved; biliary stenting led to resolution of the bile leak in 7/7 (100%) patients, and biliary stones were removed in 21/24 (87.5%) patients. In addition, 34 of 45 patients with anastomotic stricture underwent endoscopic dilation. We obtained complete resolution in 22/34 (64.7%) patients. OLT patients did not show a higher probability of complications (odds ratio [OR], 1.04), of pancreatitis (OR, 0.80) or of bleeding (OR, 1.34). Conclusions: ERCP is safe and effective for the treatment of post-OLT biliary complications, has a low rate of pancreatitis and results in a durable effect.

KW - Biliary complications

KW - Endoscopic retrograde cholangiopancreatography

KW - Liver transplant

KW - Pancreatitis

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