Safety of endoscopic retrograde cholangiopancreatography in liver transplanted patients: A single‐center retrospective study

Abstract

The incidence rate of endoscopic retrograde cholangiopancreatography complication in liver transplanted patient has not been well studied. Some studies believed such patients inherit higher complication risk in ERCP procedure owing to innate structure deformity and coagulopathy condition. Our aim of this study is to evaluate the post‐ERCP complications incidence in liver transplanted patients. All liver transplant patients (deceased donor and living‐related donor) from January 2010 to December 2015 who underwent ERCP procedure alone in Changhua Christian medical center hospital were retrospective evaluated. Data regarding post‐ERCP complications, including pancreatitis, hemorrhage, perforation, and infection, are collected and analyzed. A total of 98 ERCP procedures were performed in 43 liver transplanted patients during 5‐year period. The overall incidence rate of post ERCP complications was 13.27%. The most common complication was bleeding 6.12%, followed by pancreatitis 5.10%, perforation 2.04%, and cholangitis 1.02%. Among patients with post‐ERCP hemorrhage, more than half of the patients had delay bleeding and required more than two times of endoscopic procedure. Differ from general ERCP complications, all of the perforation events were related to bile duct injury.

Đánh giá kết quả xử trí biến chứng đường mật sau ghép gan qua nội soi mật tụy ngược dòng

“…Tỉ lệ nhiễm trùng cao có thể liên quan đến việc dùng thuốc của bệnh nhân sau ghép gan: Thuốc ức chế miễn dịch, thuốc chống đông… Ngoài ra, khó khăn trong can thiệp khiến thời gian can thiệp kéo dài, đường mật bị hẹp cũng là một trong những nguyên nhân dẫn đến tăng tỉ lệ biến chứng nhiễm khuẩn ở nhóm bệnh nhân này. Cherng-Harng Lim và cộng sự (2019) nghiên cứu có 98 lần can thiệp ERCP trên 43 bệnh nhân biến chứng đường mật sau ghép gan: Tỉ lệ mắc chung của các biến chứng là 13,27%, chảy máu là biến chứng hay gặp nhất (6,12%), tiếp đến viêm tụy (5,1%), thủng (2,04%), viêm đường mật (1,02%) [8]. Tỉ lệ biến chứng trong nghiên cứu của chúng tôi cao hơn có thể lý giải do số lượng bệnh nhân còn ít mặt khác trong nghiên cứu của chúng tôi chỉ đánh giá ở lần can thiệp ERCP đầu tiên, còn nghiên cứu trên đánh giá trên cả các lần can thiệp sau của bệnh nhân, ở những lần can thiệp sau thì mức độ khó của can thiệp ít hơn do đó tỉ lệ tại biến, biến chứng củng giảm so với lần can thiệp đầu tiên.…”

Endoscopic management for post‐living donor liver transplantation anastomotic biliary stricture: The common failure‐causing problems and their solutions

“…Occurrence of biliary complications after LDLT is characterized by small diameter of the anastomotic bile duct, biliary anatomical diversity, complex surgical procedures, local ischemia of the peribiliary plexus, and angulated duct anastomosis caused by hypertrophy of the liver graft . Based on recent reports, approximately 5% to 25% of adult recipients will develop biliary complications after LDLT …”

“…Nowadays, nonsurgical managements have largely replaced reoperation as the initial treatment of anastomotic biliary strictures even though repeated interventions are required for adequate outcome . Endoscopic treatment is the preferable first‐line option for patients receiving duct‐to‐duct biliary reconstruction for its safety and effectiveness . Successful resolution of anastomotic strictures can be achieved in 58% to 75% of patients .…”

“…3,4 Based on recent reports, approximately 5% to 25% of adult recipients will develop biliary complications after LDLT. 5 Nowadays, nonsurgical managements have largely replaced reoperation as the initial treatment of anastomotic biliary strictures even though repeated interventions are required for adequate outcome. 6 Endoscopic treatment is the preferable first-line option for patients receiving duct-to-duct biliary reconstruction for its safety and effectiveness.…”

“…6 Endoscopic treatment is the preferable first-line option for patients receiving duct-to-duct biliary reconstruction for its safety and effectiveness. 5 Successful resolution of anastomotic strictures can be achieved in 58% to 75% of patients. 7,8 Generally, therapeutic endoscopy involves completion of endoscopic retrograde cholangiography (ERC) and a guidewire cross through the stricture site.…”