A terapêutica endoscópica nas complicações biliares pós-transplante hepático / Endoscopic management of biliary complications after liver transplantation

RACIONAL: O transplante hepático é o único tratamento efetivo para as hepatopatias crônicas terminais e a taxa de sobrevida tem aumentado nas últimas décadas. No entanto, as complicações biliares têm alta incidência e permanecem como o "calcanhar de Aquiles" do transplante de fígado. OBJETIVO: Avaliar retrospectivamente os resultados do tratamento endoscópico das complicações biliares em pacientes submetidos à transplante hepático. MÉTODOS: Foram avaliados pacientes transplantados hepáticos para realização de colangiopancreatografia retrógrada endoscópica por suspeita de complicação biliar. RESULTADOS: Quinze pacientes (11 homens, média de idade de 49,57 anos) foram estudados. Nesse período foram realizadas 36 colangiopancreatografias retrógradas endoscópicas (2,4/paciente). Neste grupo, 100% receberam órgão de doador falecido. Estenose da anastomose coledococoledocociana foi diagnosticada em 13 pacientes e o sucesso da terapêutica endoscópica foi de 53,84% (38,46% ainda em tratamento). Fístula biliar foi diagnosticada em um paciente, sendo resolvida pelo tratamento endoscópico. Disfunção da âmpola hepatopancreaticobiliar com coledocolitíase foi diagnosticada em um paciente, também resolvida pela terapêutica endoscópica. CONCLUSÕES: As complicações biliares pós-transplante hepático são relativamente comuns, com predominância de estenoses. O tratamento endoscópico foi eficaz na maioria dos pacientes desta série.

BACKGROUND: Liver transplantation is the only effective treatment for chronic liver diseases and terminal survival rate has increased in recent decades. However, biliary complications have high incidence and remain as the "Achilles heel" for liver transplantation. AIM: To evaluate retrospectively endoscopic treatment outcomes of biliary complications in post-liver transplantations. METHODS: The sample consisted of post-liver transplantation patients for endoscopic retrograde cholangiopancreatography due to suspected biliary complications. RESULTS: Fifteen patients were included (10 male, mean age of 49.57 years) and 36 endoscopic retrograde cholangiopancreatographies were undertaken (2.4/patient). Biliary stricture was diagnosed in 13 patients and endoscopic treatment was successful in 56% (38,46% still in treatment). Biliary leaks were found in one patient and dysfunction of the hepatobilliary ampulla with choledocholithiasis was diagnosed in one patient, both cured by endoscopic treatment. CONCLUSIONS: Post-liver transplantation biliary complications are relatively common and endoscopic treatment may result in satisfactory outcome. Stenosis was the more frequent complication in this series.

Terapêutica endoscópica nas complicações biliares pós-transplante hepático / Endoscopic management of biliary complications after liver transplantation

Introdução: o transplante hepático é o único tratamento efetivo para as hepatopatias crônicas terminais e a taxa de sobrevida tem aumentado nas últimas décadas. No entanto, as complicações biliares têm alta incidência e permanecem como o 'calcanhar de Aquiles do transplante de fígado'. Objetivo: avaliar retrospectivamente os resultados do tratamento endoscópico das complicações biliares em pacientes submetidos a transplante hepático. Métodos: foram avaliados pacientes transplantados hepáticos encaminhados ao Serviço de Endoscopia do Hospital Geral César Calls e a uma clínica particular de endoscopia, no período de dezembro de 2004 a julho de 2011, para realização de colangiopancreatografia retrógrada endoscópica por suspeita de complicação biliar. Resultados: quinze pacientes (11 homens, média de idade de 49,57 anos) foram estudados retrospectivamente entre dezembro de 2004 a julho de 2011. Nesse período foram realizadas 36 colangiopancreatografias retrógradas endoscópicas (2,4/ pacientes). Neste grupo, 100% receberam órgão de doador falecido. Estenose da anastomose colédoco-coledocociana foi diagnosticada em 13 pacientes e o sucesso da terapêutica endoscópica nestes casos foi de 53,84% (38,46% ainda em tratamento). Fístula biliar foi diagnosticada em 1 paciente, sendo resolvida pelo tratamento endoscópico. Disfunção da ampola da Vater com coledocolitíase foi diagnosticada em 1 paciente, também resolvida pela terapêutica endoscópica. Conclusões: complicações biliares pós-transplante hepático são relativamente comuns e o tratamento endoscópico mostra bons resultados.

Introduction: liver transplantation is the only effective treatment for chronic liver diseases and terminal survival rate has increased in recent decades. However, biliary complications have high incidence and remain the 'Achilles heel of liver transplantation'. Objective: to retrospectively evaluate endoscopic treatment outcomes of biliary complications in post-liver transplants. Methods: the sample consisted of post-liver transplantation patients referred to the Endoscopy Unit of Hospital Geral Cesar Calls and to the endoscopy private clinic, from December 2004 to July 2011, for endoscopic retrograde cholangiopancreatography due to suspected biliary complications. Results: Fifteen patients were retrospectively assessed from December 2004 to July 2011 (10 male, mean age of 49.57 years) were reviewed and 36 endoscopic retrograde cholangiopancreatographies were undertaken (2.4/ patient). Biliary stricture was diagnosed in 13 patients and endoscopic treatment was successful in 56% (38.46% still in treatment). Biliary leaks were found in one patient and dysfunction of the ampulla of Vater with choledocholithiasis was diagnosed in one patient, both resolved by endoscopic treatment. Conclusions: post-liver transplantation biliary complications were relatively common and endoscopic treatment had a satisfactory outcome.

Endoscopic management of biliary complications after liver transplantation.

BACKGROUND: Liver transplantation is the only effective treatment for chronic liver diseases and terminal survival rate has increased in recent decades. However, biliary complications have high incidence and remain as the "Achilles heel" for liver transplantation. AIM: To evaluate retrospectively endoscopic treatment outcomes of biliary complications in post-liver transplantations. METHODS: The sample consisted of post-liver transplantation patients for endoscopic retrograde cholangiopancreatography due to suspected biliary complications. RESULTS: Fifteen patients were included (10 male, mean age of 49.57 years) and 36 endoscopic retrograde cholangiopancreatographies were undertaken (2.4/patient). Biliary stricture was diagnosed in 13 patients and endoscopic treatment was successful in 56% (38,46% still in treatment). Biliary leaks were found in one patient and dysfunction of the hepatobilliary ampulla with choledocholithiasis was diagnosed in one patient, both cured by endoscopic treatment. CONCLUSIONS: Post-liver transplantation biliary complications are relatively common and endoscopic treatment may result in satisfactory outcome. Stenosis was the more frequent complication in this series.