Experience With Ercp In Liver Transplanted Children

ERCP in children and infants after liver transplantation is still a special and unusual exception and limited to a few cases. We report on our experience in ERCP in a series of 19 children with complications after liver transplantation. From 1999 to 2004 19 children were referred to our endoscopic unit for ERCP procedure. All examinations were performed under general anesthesia using standard video-duodenoscopes (Olympus JF 160) or a special pediatric video-duodenoscope (7.5 mm outer diameter, Olympus PJF 160). 53 ERCP in 19 children were performed, in 3 cases the procedure has to change to a percutaneous access, in 1 case the papilla was not accessible because of post-surgical bowel distortions. The age ranged from 0.9 to 16 years, median 5.6 years, median age at transplantaion was 4 years. Indication for ERCP was cholangitis or cholestasis. The procedures lasted 7 to 150 minutes, median 90 min. In 6 cases the procedure was only diagnostic, no endoscopic intervention was indicated. In 45 procedures an intervention was intended but failed in 6 because dilatation of anastomotic stenoses was impossible. In the remaining cases/procedures interventions were: sphincterotomy n = 7, pre-cut sphincterotomy n = 8, dilatation n = 31, rinsing n = 6, naso-biliary sondes n = 2, stenting n = 4, cholangioscopy n = 2. Complications were: bleeding after sphincterotomy n = 1 (treated by injection therapy), mild pancreatitis n = 1 (managed conservatively) and biliary leakage caused by a guide-wire (treated by short-time insertion of a naso-biliary sonde). Diagnostic and therapeutic ERCP is an important procedure in managing complications after liver transplantation in children. It should be ensured that ERCPs are carried out only by expert endoscopists, in which case it is a low risk diagnostic and therapeutic procedure.