Endoscopic versus surgical management of biliary complications - Outcome analysis after 1188 orthotopic liver transplantations

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• 作者：Georg P. Gyö ; ri^a ; Remy Schwarzer^b ; Andreas Pü ; spö ; k^b ; Rainer Schö ; fl^c ; Gerd R. Silberhumer^a ; Felix B. Langer^a ; Michael Trauner^b ; Markus Peck-Radosavljevic^b ; Gabriela A. Berlakovich^a ; Arnulf Ferlitsch^b ; ^{arnulf.ferlitsch@meduniwien.ac.at" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Biliary anastomosis ; Endoscopy ; ERCP ; Hepaticojejunostomy ; Surgery
• 刊名：Digestive and Liver Disease
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：48
• 期：11
• 页码：1323-1329
• 全文大小：1105 K

文摘

After liver transplantation, the endoscopic approach has become the standard treatment modality for biliary complications. Aim of this study was to compare primary endoscopic with primary surgical management.

Patients and methods

A retrospective review on 1188 consecutive liver transplant patients between 1989 and 2009 was performed. Management strategies (endoscopic, surgical or combined approach) were evaluated for treatment success as well as patient survival.

Results

Biliary complications after liver transplantation were diagnosed in 211 (18%) patients.

Initial endoscopic approach (N = 162, 77%) was successful in 97 of 162 (60%) patients. In 80% of patients, success was achieved within a median of four ERCPs.

Sixty-one patients (38%) were referred to surgery after non-successful ERCP.

Initial surgical approach was performed in 49/211 patients (23%) with successful management in 38/49 (78%) of patients.

Patients presenting with intraluminal objects needed a significantly higher number of ERCPs to reach treatment success (median 3 versus 2 interventions, p = 0.001) but had an equal endoscopic success rate (p = 0.427).

Patients with successful endoscopic treatment showed lower mortality compared to patients with primary surgical treatment (p = 0.029).

Conclusions

Endoscopic management should be considered as the primary approach for biliary complications after liver transplantation.