Endoscopy 2020; 52(S 01): S219
DOI: 10.1055/s-0040-1704684
ESGE Days 2020 ePoster Podium presentations
Saturday, April 25, 2020 1:30 – 12:00 ERCP: Benign strictures ePoster Podium 2
© Georg Thieme Verlag KG Stuttgart · New York

EFFICACY OF ENTEROSCOPY-ASSISTED ERCP IN LIVER TRANSPLANT PATIENTS WITH ROUX-EN-Y RECONSTRUCTION AND SUSPECTED BILE DUCT PATHOLOGY

T Moreels
1   Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Gastroenterology & Hepatology, Brussels, Belgium
,
P Deprez
1   Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Gastroenterology & Hepatology, Brussels, Belgium
,
G Dahlqvist
1   Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Gastroenterology & Hepatology, Brussels, Belgium
,
B Delire
1   Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Gastroenterology & Hepatology, Brussels, Belgium
,
L Coubeau
2   Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Abdominal Transplantation, Brussels, Belgium
,
O Ciccarelli
2   Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Abdominal Transplantation, Brussels, Belgium
,
EB Riani
2   Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Abdominal Transplantation, Brussels, Belgium
,
P Goffette
3   Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Radiology, Brussels, Belgium
,
E Sokal
4   Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Pediatric Gastroenterology & Hepatology, Brussels, Belgium
,
H Piessevaux
1   Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Gastroenterology & Hepatology, Brussels, Belgium
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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Aims Feasibility of enteroscopy-assisted ERCP to evaluate/treat biliary complications in liver transplant patients with Roux-en-Y reconstruction.

Methods Between 2016 and 2019 enteroscopy-assisted ERCP procedures in liver transplant patients were analysed for indications, technical and clinical success and complications. ERCP was performed using 4 types of single-balloon enteroscopes (SBE).

Results 32 patients (25 males), mean age 42 ± 3y (range 16–81), underwent 51 enteroscopy-assisted ERCP procedures. Indications: suspicion anastomotic stricture (53%), cholangitis (31%), bile duct stones (10%), biliary leak (3%), sepsis (3%). Technical ERCP success rate per patient was 81.25% (26/32), with failure to reach the hepaticojejunal anastomosis in others. ERCP was normal in 10/26 (39%), confirmed the anastomotic stricture in 9/26 (35%), bile duct stones in 5/26 (19%) and biliary leak and indwelling metallic stent both in 1/26 (4%). Biliary interventions: balloon dilatation (6–9 mm), plastic stent insertion (4–7 Fr), stone extraction, bile duct biopsy and direct cholangioscopy in 1–6 ERCP procedures per patient (median 1). Minor adverse events (cholangitis) were seen in 4/32 (12,5%). Of all 51 ERCPs, 49% were easy, 27% were difficult or very difficult (8%) and 17% impossible. Technical success rate was highest with prototype XSIF-180JY SBE (100% for 14 procedures) and lowest with conventional SIF-Q180 SBE (50% for 6 procedures). Clinical success measured by biliary liver function tests: before start of ERCP, 1 day after and 30 days after last ERCP, with a significant decrease in gamma-GT serum levels (345 ± 90 U/L before, 257 ± 73 U/L after and 146 ± 27 U/L after 30 days, p = 0.023) and alkaline phosphatase levels (337 ± 70 U/L before, 343 ± 89 U/L after and 198 ± 53 U/L after 30 days, p = 0.044).

Conclusions Biliary endoscopic evaluation is feasible and safe using enteroscopy-assisted ERCP in liver transplant patients with Roux-en-Y reconstruction, allowing close inspection of hepaticojejunostomy and intrahepatic bile ducts. Endoscopic therapy leads to clinical improvement of liver function tests.