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Researchers find ERCP safe for biliary leakage after LT

Endoscopic retrograde cholangiopancreatography was safe and effective for the treatment of bile leakage after liver transplantation, according to recent study data.

“Biliary adverse events are the main complications after liver transplantation and are an important cause of postoperative morbidity and mortality,” the researchers wrote. “Early detection and appropriate management are critical for minimizing secondary adverse events associated with bile leakage.”

Researchers analyzed data of 1,430 patients who underwent liver transplantation at Asan Medical Center in Seoul, Korea, to determine the prevalence of biliary leakage after transplant and the efficacy of endoscopic treatment after transplant. Biliary leakage occurred in 42 patients, based on clinical symptoms, and was then confirmed with endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography.

Overall, bile leaks alone were found in 22 of the 42 patients who underwent ERCP and bile leaks with bile duct strictures were found in the other 20 patients who underwent ERCP.

In the 42 patients who underwent ERCP treatment, technical success was reached in 32 patients (76.2%) and clinical success was accomplished in 27 (64.3%).

Endoscopic treatment was successful in 19 patients with bile leakage alone (86.4%) and clinically successful in 17 patients with leakage alone (77.3%). In 20 patients with bile leaks with bile duct strictures, endoscopic treatment was technically successful in 13 patients (65%) and clinically successful in 10 patients (50%), according to the results.  

Adverse events related to ERCP were observed in 4 patients (9.5%). One patient developed a perforation after endoscopic sphincterotomy and three developed bleeding.

“ERCP is an effective treatment for patients who develop bile leaks only,” the researchers concluded. “We propose that ERCP should be considered an initial, less invasive therapeutic modality in post-liver transplantation patients.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.