To evaluate the use of endoscopic retrograde cholangiopancreatography (ERCP) in biliary complications early after orthotopic liver transplantation.

Clinical data of 39 liver transplant recipients who were admitted in the First Affiliated Hospital, University of Science and Technology of China from April 2017 to April 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 27 patients were male and 12 female, aged 19-63 years, with a median of 48 years. There were 9 cases of donation after brain death, 23 cases of donation after cardiac death and 7 cases of donation after brain death awaiting cardiac death. Patients underwent allograft classic orthotopic liver transplantation, including 38 case of end-to-end bile duct anastomosis, and 1 case of duct-jejunum Roux-en-Y anastomosis. Postoperative complications are graded according to Clavien-Dindo classification. Diagnosis and treatments for early biliary tract complications were analyzed.

4 cases developed early biliary tract complications after operation with an incidence of 10%(4/39), including 2 cases of bile duct anastomotic leakage, 1 case of simple bile duct anastomotic stenosis, 1 case of ischemic-type biliary lesion (ITBL) combined with biliary cast and recurrent retrograde biliary tract infection. ERCP were successfully performed in 4 patients for a total of 16 case-times. 2 cases with anastomotic leakage recovered after nasobiliary drainage + bile duct stenting. 1 case with simple biliary anastomotic stenosis recovered well after stenting and 1 case with ITBL combined with biliary cast and recurrent retrograde biliary tract infection recovered well after 7 attempts of ERCP. After ERCP, 1 case developed transient hyperamylasemia and was cured after conservative treatment.

ERCP is effective, safe in the diagnosis and treatment of biliary complications in the early period after orthotopic liver transplantation, and can be used as a preferred method of non-surgical treatment.