Predictive factors of postendoscopic retrograde cholangiopancreatography pancreatitis for biliary complications in living-donor liver transplantation recipients. Issue 4 (13th April 2023)

• Record Type: Journal Article
• Authors: Shehta, Ahmed; Elshobari, Mohamed; Salah, Tarek; Sultan, Ahmad M.; Yasen, Amr; Elsadany, Mohamed; Elsarraf, Waleed Rifat; Abdel-Khalek, Ehab E.; Shiha, Usama; Elebidy, Gamal; Abdel Wahab, Mohamed; El-Saadany, Mohamed
• Is Part Of: European journal of gastroenterology & hepatology. Volume 35:Issue 4(2023)
• Page Start: 359
• Page End: 364
• Publication Date: 2023-04-13
• Subjects: liver transplantation -- living donor -- pancreatitis -- ERCP; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; Digestive organs -- Diseases; Liver -- Diseases; Periodicals; 616.33
• DOI: 10.1097/MEG.0000000000002521
• Languages: English
• ISSNs: 0954-691X

Abstract

Abstract : Objectives: Endoscopic retrograde cholangiopancreatography (ERCP) has shown great safety and efficacy in the management of post-living-donor liver transplantation (LDLT) biliary complications. Pancreatitis is the most commonest and the most feared complication after ERCP. Methods: We reviewed the data of liver transplant recipients who underwent ERCP for biliary complications after LDLT between 2011 and 2022. Results: In total 63 patients underwent ERCP after LDLT. They were targeted to 134 set of ERCP. Pancreatitis occurred in 52 sets (38.8%). We subclassified the patients into two groups, without pancreatitis: 31 patients (49.2%) and with pancreatitis 32 patients (50.8%). A higher incidence of pancreatitis was noticed with the first ERCP set ( P = 0.04). Biliary strictures were more noted in the pancreatitis group ( P = 0.025). Difficult cannulation requiring precut was more observed in the pancreatitis group ( P = 0.007). Also, more frequent sphincterotomy was observed in the pancreatitis group ( P = 0.003). Longer hospital stay, more fever, abdominal pain and vomiting were noted in the pancreatitis group ( P = 0.001). Higher post-ERCP serum amylase ( P = 0.001) and creatinine ( P = 0.021), while lower serum calcium ( P = 0.21) were noticed in the pancreatitis group. On multivariate analysis, preoperative diabetes, number of biliary anastomoses (single/multiple) and difficult cannulation requiring precut were significant predictors of post-ERCP pancreatitis. Conclusion: Patient-related risk factors and bedside procedure-related risk factors play an essential role in the development of pancreatitis after ERCP for LDLT recipients. Endoscopists should be mindful by those high-risk patients during ERCP to apply appropriate techniques to prevent the development of this serious complication.