Endoscopic treatment of biliary complications after liver transplantation.

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.

Tratamiento endoscópico de las complicaciones biliares en el trasplante hepático / No disponible

INTRODUCCIÓN: las complicaciones biliares tras el trasplante hepático son una causa importante de morbimortalidad. La colangiopancreatografía retrógrada endoscópica (CPRE) es una alternativa terapéutica menos invasiva que el manejo quirúrgico. MATERIAL Y MÉTODOS: se han revisado el manejo endoscópico de las complicaciones derivadas de la reconstrucción biliar en pacientes receptores de trasplante hepático en el Complexo Hospitalario Universitario de A Coruña entre los años 2012 y 2018 y su tratamiento mediante CPRE. RESULTADOS: se estudiaron 232 pacientes receptores de trasplante hepático. Se produjeron complicaciones biliares en 70 (30,1 %). La complicación más frecuente fue la estenosis de la anastomosis biliar, generalmente colédoco-coledocal, en 43 (61,4 %) pacientes. Siguieron la fístula biliar en 16 (22,9 %), la estenosis biliar no anastomótica en seis (8,6 %) y, finalmente, la coledocolitiasis en cinco (7,1 %). Se realizaron CPRE en 39/43 pacientes con estenosis de la anastomosis y se alcanzó el éxito clínico en 36 (92,3 %). También en todos los pacientes con fístula biliar temprana, con éxito en 10/16 (62,5 %). En los cálculos biliares se consiguió éxito con la CPRE en 3/5 pacientes (60 %). En las estenosis no anastomóticas no se consiguió buen resultado endoscópico en ningún caso. Como complicaciones se registraron cinco (7,7 %) hemorragias leve-moderadas tras esfinterotomía biliar. CONCLUSIONES: en nuestro estudio, parece que la CPRE es útil en la mayoría de estenosis de anastomóticas biliares, fístulas biliares tempranas y coledocolitiasis tras el trasplante hepático. El número de complicaciones de la CPRE en estos pacientes ha sido bajo, sin ninguna mortalidad

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Self-expandable stents in malignant colonic obstruction: insertion assisted with a sphincterotome in technically difficult cases.

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.