Avoiding Pitfalls: What an Endoscopist Should Know in Liver Transplantation—Part II

Abstract

Over the last decade the number of patients undergoing transplantation has increased. At the same time, effective peri- and postoperative care and better surgical techniques have resulted in greater numbers of recipients achieving long-term survival. Identification and effective management in the form of adequate treatment is essential, since any delay in diagnosis or treatment may result in graft loss or serious threat to patient's life. Various aspects of endoscopic findings that can be commonly encountered among liver transplant recipients are discussed herein. Topics include: persistent and/or recurrent esophageal varices, reflux, Candida or cytomegalovirus (CMV) esophagitis, esophageal neoplasms, posttransplant peptic ulcer, biliary complications, posttransplant lymphoproliferative disorder (PTLD), Kaposi's sarcoma, CMV colitis and inflammatory bowel disease, colonic neoplasms, Clostridium difficile infection, and graft versus host disease (GVHD).

Complications of the treatment of endoscopic biliary strictures developing after liver transplantation

“…For these two failed cases, percutaneous transbiliary drainage was performed in one (#12) and close follow-up was undertaken in the other (#2). Balloon dilatation of strictures was performed in 21 of the sessions (10 patients) and temporary inside stents for biliary stricture were placed in 12 sessions (#1, 3,4,6,7,8,9,10); in the remaining, balloon dilatation and/or placement of nasobiliary catheters or plastic stents was undertaken as treatment for the biliary stricture ( Table 2). We placed pancreatic stents in difficult cannulation cases (8 sessions; 20.0%) to prevent post-ERCP pancreatitis.…”

Indications and Relative Utility of Lower Endoscopy in the Management ofClostridium difficileInfection

“…This was particularly true in solid organ transplant and bone marrow transplant patients, where conditions like graft versus host disease or CMV colitis can occur simultaneously with CDI and require significantly different approach in treatment and management [22]. With solid organ transplant patients, CDI is one of the most common causes of diarrhea and has been increasing in incidence since the early 2000s [23].…”

CMV infection, diagnosis and antiviral strategies after liver transplantation

“…To confirm the diagnosis of CMV‐associated biliary complications, the viral antigens or DNA should, if possible, be demonstrated from the bile duct specimens [20]. Gastrointestinal CMV infection should, also be demonstrated from the endoscopic biopsy specimens by these methods [24,75,76]. PCR or culture methods alone are not suitable for the definitive diagnosis of a tissue‐invasive infection, because they cannot localize the virus and the positive finding might be attributable to blood background and viremia [13].…”