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Published on: September 6, 2017
Role of ERCP in patients after hematopoietic stem cell transplantation
Hak N Kim1, Amin M Alousi, Jeffrey H Lee
1Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Insights
Endoscopic retrograde cholangiopancreatography (ERCP) is valuable for evaluating hepatobiliary dysfunction post-hematopoietic stem cell transplantation (HSCT). Biliary strictures, often malignant, indicate poor prognosis, while ERCP risks are acceptable in HSCT patients.
Area of Science:
- Hepatobiliary Medicine
- Transplantation Medicine
- Gastroenterology
Background:
- The diagnostic utility of ERCP in post-hematopoietic stem cell transplantation (HSCT) patients with hepatobiliary dysfunction remains unclear.
- This study aimed to clarify the role of ERCP in this specific patient population.
Purpose of the Study:
- To define the role of ERCP in evaluating hepatobiliary dysfunction after HSCT.
- To review institutional experience regarding indications, findings, and outcomes of ERCP in HSCT patients.
Main Methods:
- Retrospective review of 40 patients undergoing ERCP after HSCT between 1997 and 2009.
- Analysis of ERCP indications, findings (biliary strictures, common duct stones, other), and patient outcomes, including overall survival.
Main Results:
- Biliary strictures (17 patients) were frequently malignant, associated with 100% mortality.
- Common duct stones (10 patients) had a 30% mortality rate.
- Patients without stones or strictures (13 patients) had a mortality rate of approximately 77%, with causes including GVHD, drug toxicity, and malignancy recurrence.
Conclusions:
- ERCP is indicated in approximately 1 in 130 post-HSCT patients.
- Biliary strictures post-HSCT are often linked to malignancy.
- ERCP demonstrates acceptable procedural risks in HSCT patients.
Background:
The role of ERCP in evaluating patients with hepatobiliary dysfunction after hematopoietic stem cell transplantation (HSCT) has not been well-defined.
Objective:
The aim of this study was to better define the role of ERCP after HSCT by reviewing our institutional experience, including indications, findings, and outcomes.
Design:
Retrospective review of ERCP findings and outcomes in patients after HSCT.
Setting:
MD Anderson Cancer Center from 1997 to 2009.
Patients:
A total of 40 patients had ERCP after HSCT during the study period.
Intervention:
ERCP.
Main Outcome Measurements:
Overall survival.
Results:
A total of 40 patients had ERCP after HSCT during the study period. Seventeen patients had biliary strictures (group 1), and 13 proved to be malignant. Ten patients had common duct stones (group 2). Thirteen patients (group 3) had neither stones nor stricture. Findings in group 3 included bile duct leak (1), dilation without stricture (2), resolution of pretransplant strictures (3), biliary sludge (1), or normal ducts (6). The normal subset proved to have hepatic graft-versus-host disease (GVHD) (3), hepatic drug toxicity (1), hepatic recurrence of myeloma (1), or pancreatitis with biliary sludge (1). Patients with GI GVHD were equally distributed among the 3 groups. Group 1 had 100% mortality with median time to death being 85 days after ERCP. Group 2 had 30% mortality with median time to death of 584 days after ERCP. Ten of 13 patients in Group 3 died at a median of 148 days after ERCP. The only procedural complication was a mild case of pancreatitis.
Limitations:
Retrospective study at a single center.
Conclusion:
One in every 130 post-HSCT patients required ERCP evaluation. Biliary stricture is frequently caused by recurrent or new malignancy, particularly after autologous HSCT. GI GVHD is not associated with biliary stricture. ERCP procedural risks in HSCT patients are acceptable.
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