Strategies for Success in Endoscopic Retrograde Cholangiopancreatography (ERCP) Intervention in Liver Transplant Patients with Biliary Complications and Altered Intestinal Anatomy

Document Type

Conference Proceeding

Publication Date

8-1-2025

Publication Title

Am J Transplant

Abstract

Purpose: Surgically altered anatomy in patients who undergo Liver Transplant (LT) offers a unique challenge to endoscopists. There is limited data regarding the optimal endoscopic approach for the management of biliary complications in this population. We aim to assess the safety, efficacy and outcomes of various endoscopic approaches to managing patients with altered anatomy following LT. Methods: Retrospective data was collected after study approval from our IRB. Individuals who had a history of LT and surgically altered anatomy who subsequently underwent an ERCP from 2017-2024 were selected. Individual charts were reviewed to collect demographic and procedural data. Outcomes included post-procedure complications and technical success. Results: 61 patients were identified who had surgically altered anatomy with a history of LT. Of these, 13 underwent ERCP, for a total of 29 procedures. 24 ERCPs were done in patients with hepaticojejunostomy (HJ), and 5 in Roux-en-Y gastric bypass (RYGB). For patients with HJ, 6(25%) ERCPs were done within 6 months of LT, whereas 2(40%) were done in this timeframe for RYGB. Indications for both groups included jaundice(N=11, 38%), stent management(N=9, 31%), sepsis(N=6, 21%), and others. For the two patients who had RYGB, one had EDGE procedure with same day ERCP and three subsequent ERCPs through the gastrogastric fistula via the lumen apposing metal stent. The other patient had laparoscopy assisted ERCP. For patients with HJ anatomy, adult colonoscope was used in 15(26%) procedures, pediatric colonoscope for 4(17%) procedures, single balloon enteroscope for 4(17%) procedures and 1(4%) was done with a duodenoscope. Rigidizing overtube was used in 9(37.5%) of these procedures. Of these, 6(25%) were unsuccessful, with inability to reach HJ with colonoscope (N=3), excessive looping with single balloon enteroscope (N=1), and inability to locate HJ (N=2). Percutaneous Transhepatic Cholangiogram (PTC) drain placement was required in 3 of the unsuccessful procedures. Adverse events included esophageal mucosal breaks (N=2). Conclusions: We highlight the favorable success rate of endoscopic interventions in this population, with minimal adverse events. This suggest that ERCP can be a first step in managing biliary disease in post-LT patients with altered anatomy. Furthermore, successful interventions through ERCP can reduce the rate of PTC drain placement and the risk of infection related to PTC. Endoscopists should be aware of the various techniques and equipment available for technical success. Larger studies need to be done to establish guidelines for this indication. [Formula presented] CITATION INFORMATION: Faisal M., Faisal M., Saleem A., Karmo B., Hasso M., Chaudhary A., Shahzil M., Jafri S., Zuchelli T. Strategies for Success in Endoscopic Retrograde Cholangiopancreatography (ERCP) Intervention in Liver Transplant Patients with Biliary Complications and Altered Intestinal Anatomy AJT, Volume 25, Issue 8 Supplement 1 DISCLOSURES: M. Faisal: None.

Volume

25

Issue

8

First Page

S464

Last Page

S465

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