Increased incidence of gastric food retention during endoscopic retrograde cholangiopancreatography in liver transplant recipients: A retrospective cohort study

doi:10.5500/wjt.v15.i4.108159

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World Journal of Transplantation

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2220-3230

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Transplant. Dec 18, 2025; 15(4): 108159
Published online Dec 18, 2025. doi: 10.5500/wjt.v15.i4.108159

Increased incidence of gastric food retention during endoscopic retrograde cholangiopancreatography in liver transplant recipients: A retrospective cohort study

Sitong Chen, Vicki McGarrigle, Rhys Vaughan, Yuto Shimamura, Sujievvan Chandran, Leonardo Zorron Cheng Tao Pu, Marios Efthymiou

Sitong Chen, Rhys Vaughan, Yuto Shimamura, Sujievvan Chandran, Leonardo Zorron Cheng Tao Pu, Marios Efthymiou, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne 3000, Victoria, Australia

Vicki McGarrigle, Rhys Vaughan, Yuto Shimamura, Sujievvan Chandran, Leonardo Zorron Cheng Tao Pu, Marios Efthymiou, Department of Gastroenterology and Hepatology, Austin Health, Heidelberg 3084, Victoria, Australia

Co-corresponding authors: Leonardo Zorron Cheng Tao Pu and Marios Efthymiou.

Author contributions: McGarrigle V, Vaughan R, Chandran S, Pu LZCT and Marios Efthymiou conceptualized and designed the study; Vaughan R, Chandran S, Pu LZCT and Marios Efthymiou were responsible for the study supervision; all authors were involved in data extraction, analysis, and/or interpretation; Chen S, McGarrigle V and Pu LZCT were involved in the statistical analyses; all authors helped with interpretation of the results and drafting the manuscript; Vaughan R, Shimamura Y, Chandran S, Pu LZCT and Efthymiou M carried the critical revision of the article for important intellectual content; Pu LZCT and Efthymiou M played important and indispensable roles in the manuscript preparation as the co-corresponding authors.

Institutional review board statement: This study received ethical approval from the Health Human Research Ethics Committee of Victoria Translational Research Institute (HREC/107308/Austin-2024) and was conducted in accordance with the Declaration of Helsinki.

Informed consent statement: As this was a retrospective study using anonymised clinical data, individual informed consent was waived, with appropriate privacy protections in place.

Conflict-of-interest statement: All authors declare no conflicts of interest.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement- checklist of items.

Data sharing statement: The data that support the findings of this study are available on request from the corresponding author.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Marios Efthymiou, Department of Gastroenterology and Hepatology, Austin Health, Level 8, Harold Stokes Building Austin Hospital 145 Studley Road Heidelberg VIC, Heidelberg 3084, Victoria, Australia. marios.efthymiou@austin.org.au

Received: April 8, 2025
Revised: May 9, 2025
Accepted: August 4, 2025
Published online: December 18, 2025
Processing time: 225 Days and 23.1 Hours

Abstract

BACKGROUND

Gastric food retention during endoscopic retrograde cholangiopancreatography (ERCP) can lead to complications such as aspiration and failed procedure. Liver transplant (LT) recipients are exposed to an increased risk of impaired gastrointestinal motility due to surgical alterations, immunosuppressive therapy, and post-transplant complications. Given the high frequency of ERCP in this population, our anecdotal experience suggests an increased incidence of gastric food retention at the time of the procedure.

AIM

To evaluate the association between LT and gastric food retention observed at ERCP over a two-year period.

METHODS

This retrospective study included all patients who underwent standard ERCP at our institution between 2022 and 2024. Data were collected on demographics, medical history including LT and procedural details.

RESULTS

A total of 1100 patients underwent ERCP, including 238 LT recipients (22%). Gastric food retention was observed 17 patients (1.5%). The incidence was significantly higher in LT recipients compared to non-transplant patients (3.8% vs 0.9%, P = 0.004). Multivariate analysis confirmed that LT recipients were independently associated with an increased risk of food retention.

CONCLUSION

LT recipients demonstrated over three-fold increased incidence of gastric food retention during ERCP. This should be considered in pre-procedural assessment and preparation in this patient population.

Keywords: Liver transplantation; Endoscopic retrograde cholangiopancreatography; Gastroparesis; Gastric stasis; Gastric food retention; Endoscopy

Core Tip: To our knowledge, no previous studies have specifically investigated the real-world incidence of gastric food retention during endoscopic retrograde cholangiopancreatography in liver transplant (LT) recipients compared to non-LT patients. This study identified a more than three-fold increase in the incidence of gastric food retention among LT recipients. Given the potential risks associated with procedures performed under sedation or general anaesthesia, this study highlights the need for the heightened awareness to minimise the risk of airway compromise, procedural complications, and the burdens of repeated procedures in this patient cohort.