Endoscopic treatment of biliary stones in patients with liver transplantation

Biliary complications develop in 10-40 % of patients following liver transplantation. Biliary strictures, leaks, and stone are the most common type of complications. In this study, we focused on the endoscopic treatment of biliary stones.

Among 142 patients with liver transplantation [22 deceased donor related (DDLT), 120 live donor related liver transplantation (LDLT)] who underwent endoscopic retrograde cholangiopancreatography (ERCP) between December 2013 and September 2015, 33 (11 with DDLT, 28 male, mean age 45 ± 13 years) had one or more biliary stones. ERCP was performed through papilla in all of the patients other than a patient with hepaticojejunostomy.

Biliary stones were extracted in all 6 patients without anastomosis stricture (AS), 3 of 6 (50 %) patients with DDLT and AS, in 13 of 16 (81.5 %) patients with LDLT and AS, and in 3 of 5 (60 %) patients with non-anastomosis stricture (NAS). The total number of sessions required for the extraction of stones was less in patients with biliary stones without AS [1.5 (1-2)] compared to those with AS and DDLT [2 (1-6)] or LDLT [3 (1-5)]. Patients with NAS (n = 5) required a greater number of sessions [7 (1-10)].

Stone extraction is difficult in patients with NAS and requires a greater number of ERCP sessions. The treatment of biliary stones proximal to an AS in patients with DDLT or LRLT is possible in most cases.