Utility of endoscopic evaluations in liver transplant candidates

The aim of this study was to determine whether endoscopic evaluation of patients referred for liver transplant evaluation contributes significantly to patient selection or management.

Esophagogastroduodenoscopy (EGD) was performed in transplant candidates who had not undergone this examination within a previous 6-month period. Colonoscopy (CSP) was performed if the patient was >50 yr of age or had anemia, a history of colonic pathology such as adenomatous polyps, or a history suggesting gastrointestinal tract abnormalities.

A total of 118 patients were studied. EGD was performed in 74 (63%) patients. Forty-seven patients had esophageal varices identified; in 26, this represented a new diagnosis. Other findings on EGD included portal gastropathy (21 patients), gastric varices (seven patients), peptic ulceration (10 patients), Barrett's esophagus (three patients), and one case each of esophageal and gastric carcinoma. CSP was performed in 56 patients. Findings included adenomatous polyps (24 patients) and one case of colon carcinoma. Overall, gastrointestinal pathology was discovered in 67 (57%) of the patients undergoing endoscopic evaluation as part of our study. Alterations in patient selection or management resulted from 44% of the procedures performed; 42% of the patients were affected by these management changes and 2.5% of patients were removed from further transplant evaluation because of the diagnosis of malignancy.

Endoscopic evaluation of liver transplant candidates often identifies important gastrointestinal pathology and frequently impacts patient selection and management before OLT.