Endoscopic management of bile leaks after liver transplantation: An analysis of two high-volume transplant centers

Oriol Sendino, Alejandro Fernández-Simon, Ryan Law, Barham Abu Dayyeh, Michael Leise, Karina Chavez-Rivera, Henry Cordova, Jordi Colmenero, Gonzalo Crespo, Cristina Rodriguez de Miguel, Constantino Fondevila, Josep Llach, Miquel Navasa, Todd Baron, Andrés Cárdenas

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Bile leak after liver transplantation (LT) is commonly treated with endoscopic retrograde cholangiopancreatography (ERCP); however, there are limited data regarding the optimal treatment strategy. Objective: We aimed to examine the role of ERCP in LT recipients with bile leaks at two large institutions. Methods: We reviewed all ERCPs performed in LT recipients with bile leak and duct-to-duct biliary anastomosis at two high-volume transplant centers. Results: Eighty patients were included. Forty-seven (59%) patients underwent ERCP with plastic stent placement (with or without sphincterotomy) and 33 patients (41%) underwent sphincterotomy alone. Complete resolution was obtained in 94% of the stent group vs. 58% of the sphincterotomy group (p < 0.01). There was no difference in three-month survival among both groups. Percutaneous transhepatic therapy and surgery were required in 4% and 6% in the stent group vs. 12% and 42% in the sphincterotomy group, respectively (p = 0.22 and p < 0.001). The only predictive factor of bile leak resolution was stent placement. Conclusion: ERCP with plastic stent placement is highly successful and more effective than sphincterotomy alone for post-LT bile leak treatment. These results indicate that ERCP and plastic stent placement should be considered the standard of care for the treatment of bile leaks in LT.

Original languageEnglish (US)
Pages (from-to)89-96
Number of pages8
JournalUnited European Gastroenterology Journal
Volume6
Issue number1
DOIs
StatePublished - Feb 1 2018

Fingerprint

Endoscopic Retrograde Cholangiopancreatography
Bile
Liver Transplantation
Stents
Transplants
Plastics
Therapeutics
Standard of Care
Bile Ducts
Survival

Keywords

  • Bile leak
  • biliary complications
  • biliary stenting
  • biliary strictures
  • endoscopic retrograde cholangiopancreatography
  • liver transplantation
  • plastic stents
  • sphincterotomy

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology

Cite this

Sendino, O., Fernández-Simon, A., Law, R., Abu Dayyeh, B., Leise, M., Chavez-Rivera, K., ... Cárdenas, A. (2018). Endoscopic management of bile leaks after liver transplantation: An analysis of two high-volume transplant centers. United European Gastroenterology Journal, 6(1), 89-96. https://doi.org/10.1177/2050640617712869

Endoscopic management of bile leaks after liver transplantation : An analysis of two high-volume transplant centers. / Sendino, Oriol; Fernández-Simon, Alejandro; Law, Ryan; Abu Dayyeh, Barham; Leise, Michael; Chavez-Rivera, Karina; Cordova, Henry; Colmenero, Jordi; Crespo, Gonzalo; Rodriguez de Miguel, Cristina; Fondevila, Constantino; Llach, Josep; Navasa, Miquel; Baron, Todd; Cárdenas, Andrés.

In: United European Gastroenterology Journal, Vol. 6, No. 1, 01.02.2018, p. 89-96.

Research output: Contribution to journalArticle

Sendino, O, Fernández-Simon, A, Law, R, Abu Dayyeh, B, Leise, M, Chavez-Rivera, K, Cordova, H, Colmenero, J, Crespo, G, Rodriguez de Miguel, C, Fondevila, C, Llach, J, Navasa, M, Baron, T & Cárdenas, A 2018, 'Endoscopic management of bile leaks after liver transplantation: An analysis of two high-volume transplant centers', United European Gastroenterology Journal, vol. 6, no. 1, pp. 89-96. https://doi.org/10.1177/2050640617712869
Sendino, Oriol ; Fernández-Simon, Alejandro ; Law, Ryan ; Abu Dayyeh, Barham ; Leise, Michael ; Chavez-Rivera, Karina ; Cordova, Henry ; Colmenero, Jordi ; Crespo, Gonzalo ; Rodriguez de Miguel, Cristina ; Fondevila, Constantino ; Llach, Josep ; Navasa, Miquel ; Baron, Todd ; Cárdenas, Andrés. / Endoscopic management of bile leaks after liver transplantation : An analysis of two high-volume transplant centers. In: United European Gastroenterology Journal. 2018 ; Vol. 6, No. 1. pp. 89-96.
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abstract = "Background: Bile leak after liver transplantation (LT) is commonly treated with endoscopic retrograde cholangiopancreatography (ERCP); however, there are limited data regarding the optimal treatment strategy. Objective: We aimed to examine the role of ERCP in LT recipients with bile leaks at two large institutions. Methods: We reviewed all ERCPs performed in LT recipients with bile leak and duct-to-duct biliary anastomosis at two high-volume transplant centers. Results: Eighty patients were included. Forty-seven (59{\%}) patients underwent ERCP with plastic stent placement (with or without sphincterotomy) and 33 patients (41{\%}) underwent sphincterotomy alone. Complete resolution was obtained in 94{\%} of the stent group vs. 58{\%} of the sphincterotomy group (p < 0.01). There was no difference in three-month survival among both groups. Percutaneous transhepatic therapy and surgery were required in 4{\%} and 6{\%} in the stent group vs. 12{\%} and 42{\%} in the sphincterotomy group, respectively (p = 0.22 and p < 0.001). The only predictive factor of bile leak resolution was stent placement. Conclusion: ERCP with plastic stent placement is highly successful and more effective than sphincterotomy alone for post-LT bile leak treatment. These results indicate that ERCP and plastic stent placement should be considered the standard of care for the treatment of bile leaks in LT.",
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AU - Leise, Michael

AU - Chavez-Rivera, Karina

AU - Cordova, Henry

AU - Colmenero, Jordi

AU - Crespo, Gonzalo

AU - Rodriguez de Miguel, Cristina

AU - Fondevila, Constantino

AU - Llach, Josep

AU - Navasa, Miquel

AU - Baron, Todd

AU - Cárdenas, Andrés

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N2 - Background: Bile leak after liver transplantation (LT) is commonly treated with endoscopic retrograde cholangiopancreatography (ERCP); however, there are limited data regarding the optimal treatment strategy. Objective: We aimed to examine the role of ERCP in LT recipients with bile leaks at two large institutions. Methods: We reviewed all ERCPs performed in LT recipients with bile leak and duct-to-duct biliary anastomosis at two high-volume transplant centers. Results: Eighty patients were included. Forty-seven (59%) patients underwent ERCP with plastic stent placement (with or without sphincterotomy) and 33 patients (41%) underwent sphincterotomy alone. Complete resolution was obtained in 94% of the stent group vs. 58% of the sphincterotomy group (p < 0.01). There was no difference in three-month survival among both groups. Percutaneous transhepatic therapy and surgery were required in 4% and 6% in the stent group vs. 12% and 42% in the sphincterotomy group, respectively (p = 0.22 and p < 0.001). The only predictive factor of bile leak resolution was stent placement. Conclusion: ERCP with plastic stent placement is highly successful and more effective than sphincterotomy alone for post-LT bile leak treatment. These results indicate that ERCP and plastic stent placement should be considered the standard of care for the treatment of bile leaks in LT.

AB - Background: Bile leak after liver transplantation (LT) is commonly treated with endoscopic retrograde cholangiopancreatography (ERCP); however, there are limited data regarding the optimal treatment strategy. Objective: We aimed to examine the role of ERCP in LT recipients with bile leaks at two large institutions. Methods: We reviewed all ERCPs performed in LT recipients with bile leak and duct-to-duct biliary anastomosis at two high-volume transplant centers. Results: Eighty patients were included. Forty-seven (59%) patients underwent ERCP with plastic stent placement (with or without sphincterotomy) and 33 patients (41%) underwent sphincterotomy alone. Complete resolution was obtained in 94% of the stent group vs. 58% of the sphincterotomy group (p < 0.01). There was no difference in three-month survival among both groups. Percutaneous transhepatic therapy and surgery were required in 4% and 6% in the stent group vs. 12% and 42% in the sphincterotomy group, respectively (p = 0.22 and p < 0.001). The only predictive factor of bile leak resolution was stent placement. Conclusion: ERCP with plastic stent placement is highly successful and more effective than sphincterotomy alone for post-LT bile leak treatment. These results indicate that ERCP and plastic stent placement should be considered the standard of care for the treatment of bile leaks in LT.

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