Clinical Research
Copyright ©2005 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2005; 11(19): 2945-2948
Published online May 21, 2005. doi: 10.3748/wjg.v11.i19.2945
Diagnosis of biliary strictures after liver transplantation: Which is the best tool?
Thomas Zoepf, Evelyn J. Maldonado-Lopez, Philip Hilgard, Alexander Dechêne, Massimo Malago, Christoph E. Broelsch, Joerg Schlaak, Guido Gerken
Thomas Zoepf, Evelyn J. Maldonado-Lopez, Philip Hilgard, Alexander Dechêne, Massimo Malago, Christoph E. Broelsch, Joerg Schlaak, Guido Gerken, Department of Gastroenterology and Hepatology, University Hospital of Essen
Thomas Zoepf, Evelyn J. Maldonado-Lopez, Philip Hilgard, Alexander Dechêne, Joerg Schlaak, Guido Gerken, Christoph E. Broelsch, Department of General Surgery and Transplantation, University Hospital of Essen: Massimo Malago
Author contributions: All authors contributed equally to the work.
Correspondence to: Thomas Zoepf, MD, Department of Gastroenterology and Hepatology, University Hospital Essen, Hufelandstr. 55, D-45147 Essen, Germany. thomas.zoepf@uni-essen.de
Telephone: +49-201-723 3610 Fax: +49-201-723 5745
Received: September 22, 2004
Revised: September 23, 2004
Accepted: September 30, 2004
Published online: May 21, 2005
Abstract

AIM: To evaluate the diagnostic value of different indirect methods like biochemical parameters, ultrasound (US) analysis, CT-scan and MRI/MRCP in comparison with endoscopic retrograde cholangiography (ERC), for diagnosis of biliary complications after liver transplantation.

METHODS: In 75 patients after liver transplantation, who received ERC due to suspected biliary complications, the result of the cholangiography was compared to the results of indirect imaging methods performed prior to ERC. The cholangiography showed no biliary stenosis (NoST) in 25 patients, AST in 27 and ITBL in 23 patients.

RESULTS: Biliary congestion as a result of AST was detected with a sensitivity of 68.4% in US analysis (specificity 91%), of 71% in MRI (specificity 25%) and of 40% in CT (specificity 57.1%). In ITBL, biliary congestion was detected with a sensitivity of 58.8% in the US, 88.9% in MRI and of 83.3% in CT. However, as anastomotic or ischemic stenoses were the underlying cause of biliary congestion, the sensitivity of detection was very low. In MRI detected the dominant stenosis at a correct localization in 22% and CT in 10%, while US failed completely. The biochemical parameters, showed no significant difference in bilirubin (median 5.7; 4,1; 2.5 mg/dL), alkaline phosp-hatase (median 360; 339; 527 U/L) or gamma glutamyl transferase (median 277; 220; 239 U/L) levels between NoST, AST and ITBL.

CONCLUSION: Our data confirm that indirect imaging methods to date cannot replace direct cholangiography for diagnosis of post transplant biliary stenoses. However MRI may have the potential to complement or precede imaging by cholangiography. Optimized MRCP-processing might further improve the diagnostic impact of this method.

Keywords: ERCP; Liver transplantation; Biliary strictures; Endoscopy; Therapy; Ultrasound; MRCP; Diagnosis