ERCP and Liver Transplantation in a tertiary referral Hospital: Technique Evolution and Management of Biliary Complications

Aims Biliary complications are an important cause of morbidity and mortality after orthotopic liver transplantation (OLT), the most frequent are biliary tract strictures, leaks, duct stones (incidence ranging between 5% and 25%). Most complications can be managed successfully with endoscopic retrograde cholangiography (ERCP). Aim of our study was to analyze success rates of endoscopic management of post-OLT anastomotic biliary strictures in our Italian third referral centre.

Methods This observational retrospective single-centre study analyzed a 14 years case series. We included demographic data, reasons of OLT and patients outcomes after ERCP. 316 patients experienced OLT in our hospital from January 1, 2010, until April 30, 2024. 167 of them underwent ERCP for management of anastomotic biliary complications. A total of 562 ERCP were performed [1] [2] [3] [4] [5]. Endoscopic and clinical success was defined by the achievement of procedural goals associated to clinical, laboratory, and radiologic improvement. Statistical significance was tested with chi-squared test and Fisher's exact test.

Results The etiological causes leading to OLT were compared by stratifying patients depending on whether ERCP was performed or not. Analyzing patients transplanted for viral etiology, 43.71% underwent ERCP if compared to 32.21% of patients who didn't need ERCP (73/48 cases, p=0.0297). The most frequent viral etiology was hepatitis B virus (p=0.0209). There was no statistical difference on ERCP needs for patients trasplanted for other reasons. Concerning endoscopic management of anastomotic biliary stenosis, firstly we analyzed plastic monostenting vs multistenting outcomes. Endoscopic success was similar (97.20% vs 100% respectively) but clinical success showed a significant difference (83.18% vs 94%, p=0.0151). In addition, we evaluated the efficacy of antimigration fully covered self-expandable metal stents (Am-fcSEMS) compared to standard ones (Std-fcSEMS) after multistenting failure in 25 subjects. Endoscopic success was 93.33% in the Std-fcSEMS group (14/15) and 100% in the Am-fcSEMS group (10/10). Clinical success was achieved in 86.7% with Std-fcSEMS and in 100% with Am-fcSEMS (p=0.5).

Conclusions As in literature, plastic multistenting achieves higher endoscopic and clinical success rates if compared with monostenting. The Am-fcSEMS can represent a valid approach, even if a significant difference in clinical success if compared to Std-fcSEMS did not emerge in our study probably due to our small sample size. A significant increase of ERCP needs in patients transplanted for viral etiology (particularly hepatitis B) is a new interesting finding, the reason is not clear and further studies should address to this topic.

Publication History

Article published online:
27 March 2025

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