RESUMEN
BACKGROUND: biliary complications are an important cause of morbidity and mortality after liver transplantation. Endoscopic retrograde cholangiopancreatography (ERCP) is a therapeutic option, which is less invasive than surgical management. MATERIALS AND METHODS: the endoscopic management with ERCP of patients with biliary complications after liver transplantation in the Complexo Hospitalario Universitario de A Coruña between 2012 and 2018 was reviewed. RESULTS: there were 232 liver transplant recipients and biliary complications occurred in 70 (30.1 %) patients. Anastomotic strictures, most of them choledocho-choledochal, constituted the most frequent complication in 43 (61.4 %) patients. Biliary leak occurred in 16 (22.9 %) patients, non-anastomotic strictures in six (8.6 %) and choledocholithiasis in five (7.1 %). ERCP was performed in 39/43 patients with anastomotic strictures, achieving clinical success in 36 (92.3 %). All patients with a biliary leak were treated with CPRE, with a clinical resolution in 10/16 (62.5 %). ERCP was successful in 3/5 patients (60 %) with bile duct stones. In non-anastomotic strictures, ERCP was not effective in any case. Regarding complications, five (7.7 %) patients presented mild-moderate bleeding after biliary sphincterotomy. CONCLUSION: in our study, ERCP is useful in most biliary anastomotic strictures, early biliary leaks and choledocholithiasis after liver transplantation. The rate of ERCP complications in these patients was low and none were lethal.
Asunto(s)
Enfermedades de las Vías Biliares , Coledocolitiasis , Trasplante de Hígado , Enfermedades de las Vías Biliares/diagnóstico por imagen , Enfermedades de las Vías Biliares/epidemiología , Enfermedades de las Vías Biliares/etiología , Colangiopancreatografia Retrógrada Endoscópica , Humanos , Trasplante de Hígado/efectos adversos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Estudios RetrospectivosRESUMEN
BACKGROUND: Stent placement is effective in relieving malignant colonic obstruction. Nevertheless, the technique may offer difficulties in sharply angulated lesions. METHODS: Guidewire insertion assisted with a sphincterotome was performed in 4 patients with intestinal obstruction caused by malignant colonic strictures. The manipulation of the sphincterotome by turning and bending its tip allows the cannulation of the lesion with the guidewire and, as a consequence, the stent insertion. OBSERVATIONS: The procedure was successfully performed in 4 technically difficult cases in which it had been impossible to pass the guidewire with the standard catheter. CONCLUSIONS: In technically difficult cases, with the use of a sphincterotome, insertion of the guidewire appears to be easier. This new method may improve technical success rates in stent placement.
