Predictive factors of postendoscopic retrograde cholangiopancreatography pancreatitis for biliary complications in living-donor liver transplantation recipients.

Autor:	Shehta A; Department of Surgery, Gastrointestinal Surgery Center., Elshobari M; Department of Surgery, Gastrointestinal Surgery Center., Salah T; Department of Surgery, Gastrointestinal Surgery Center., Sultan AM; Department of Surgery, Gastrointestinal Surgery Center., Yasen A; Department of Anesthesia, Liver Transplantation Unit., Elsadany M; Department of Hepatology, Liver Transplantation Unit., Elsarraf WR; Department of Anesthesia, Liver Transplantation Unit., Abdel-Khalek EE; Department of Hepatology, Liver Transplantation Unit., Shiha U; Department of Radiology, Gastrointestinal Surgery Center, Faculty of Medicine, Mansoura University, Egypt., Elebidy G; Department of Surgery, Gastrointestinal Surgery Center., Abdel Wahab M; Department of Surgery, Gastrointestinal Surgery Center., Samy M; Department of Hepatology, Liver Transplantation Unit.
Jazyk:	angličtina
Zdroj:	European journal of gastroenterology & hepatology [Eur J Gastroenterol Hepatol] 2023 Apr 01; Vol. 35 (4), pp. 359-364. Date of Electronic Publication: 2023 Feb 13.
DOI:	10.1097/MEG.0000000000002521
Abstrakt:	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. (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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