Endoscopic management of biliary leaks after T-tube removal in liver transplant recipients

Nasobiliary drainage versus biliary stenting

Sammy Saab, Paul Martin, George Y. Soliman, Gustavo A. Machicado, Bennett E. Roth, Gregg Kunder, Steven Huy B Han, Douglas G. Farmer, R. Mark Ghobrial, Ronald W. Busuttil, Rudolph A. Bedford

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

This study presents the long-term sequelae of endoscopic retrograde cholangiopancreatography (ERCP)-managed biliaryleakage in patients who underwent orthotopic liver transplantation (OLT) and compares the relative efficacy, safety, and charges of nasobiliary drainage (NBD) versus biliary stenting (BS). We identified all orthotopic liver transplant recipients from January 1, 1993, to December 31, 1997, who had undergone ERCP for biliary leakage. Clinical outcome and charges were calculated on an intention-to-treat basis according to initial endoscopic therapy. Of the 1,166 adult OLTs performed during the study period, 442 patients underwent elective T-tube removal. ERCP was attempted in 69 patients (16%) who developed biliary leakage after T-tube removal. Three patients (5%) in whom initial ERCP was unsuccessful underwent surgery. NBD and BS were used as primary therapy in 45 (68%) and 21 patients (32%), respectively. Three patients initially treated with NBD required reendoscopy or surgery compared with 6 patients initially treated with BS (P < .05). Although not statistically significant, there was a trend toward greater expense in the BS group compared with the NBD group. ERCP is a safe and effective method of managing biliary leakage after T-tube removal in orthotopic liver transplant recipients. However, our results suggest NBD is the preferred method because recurrent leaks were more common in patients treated initially with BS. With prompt use of ERCP, surgery is rarely needed for this complication of OLT.

Original languageEnglish
Pages (from-to)627-632
Number of pages6
JournalLiver Transplantation
Volume6
Issue number5
StatePublished - Sep 26 2000
Externally publishedYes

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Drainage
Endoscopic Retrograde Cholangiopancreatography
Liver
Liver Transplantation
Transplant Recipients
Safety
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Saab, S., Martin, P., Soliman, G. Y., Machicado, G. A., Roth, B. E., Kunder, G., ... Bedford, R. A. (2000). Endoscopic management of biliary leaks after T-tube removal in liver transplant recipients: Nasobiliary drainage versus biliary stenting. Liver Transplantation, 6(5), 627-632.

Endoscopic management of biliary leaks after T-tube removal in liver transplant recipients : Nasobiliary drainage versus biliary stenting. / Saab, Sammy; Martin, Paul; Soliman, George Y.; Machicado, Gustavo A.; Roth, Bennett E.; Kunder, Gregg; Han, Steven Huy B; Farmer, Douglas G.; Ghobrial, R. Mark; Busuttil, Ronald W.; Bedford, Rudolph A.

In: Liver Transplantation, Vol. 6, No. 5, 26.09.2000, p. 627-632.

Research output: Contribution to journalArticle

Saab, S, Martin, P, Soliman, GY, Machicado, GA, Roth, BE, Kunder, G, Han, SHB, Farmer, DG, Ghobrial, RM, Busuttil, RW & Bedford, RA 2000, 'Endoscopic management of biliary leaks after T-tube removal in liver transplant recipients: Nasobiliary drainage versus biliary stenting', Liver Transplantation, vol. 6, no. 5, pp. 627-632.
Saab, Sammy ; Martin, Paul ; Soliman, George Y. ; Machicado, Gustavo A. ; Roth, Bennett E. ; Kunder, Gregg ; Han, Steven Huy B ; Farmer, Douglas G. ; Ghobrial, R. Mark ; Busuttil, Ronald W. ; Bedford, Rudolph A. / Endoscopic management of biliary leaks after T-tube removal in liver transplant recipients : Nasobiliary drainage versus biliary stenting. In: Liver Transplantation. 2000 ; Vol. 6, No. 5. pp. 627-632.
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