Zhang Chengcheng Christine, Koschny Ronald, Rupp Christian, Michl Patrick, Mehrabi Arianeb, Wehling Cyrill, Kantowski Marcus, Sauer Peter
Department of Gastroenterology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
Interdisciplinary Center of Endoscopy, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
BMC Surg. 2025 Aug 9;25(1):353. doi: 10.1186/s12893-025-03106-1.
Biliary strictures after liver transplantation are associated with significant morbidity and mortality. Endoscopic retrograde cholangiopancreatography (ERCP) is the preferred approach. Post-ERCP cholangitis is a complication of this procedure. We aimed to evaluate the incidence of post-ERCP cholangitis in patients with post-transplant biliary strictures, their impact on survival, and identify potential risk factors.
This retrospective study evaluated liver transplant recipients with biliary strictures treated with balloon dilatation at defined intervals. Primary clinical endpoints were the incidence of post-ERCP cholangitis, overall survival, and identification of potential risk factors.
Two hundred patients with a median follow-up period of 6 years (IQR 2-10 years) were included. Anastomotic and non-anastomotic strictures were diagnosed in 132 and 68 patients, respectively. Overall, 930 ERCP procedures were performed, and post-ERCP cholangitis was detected in 148 procedures (15.9%). Patients with post-ERCP cholangitis showed significantly worse overall survival rates (median, 9 vs. 15 years; log-rank test, p < 0.001), were significantly more frequently diagnosed with non-anastomotic strictures (44.6% vs. 25%; p = 0.004), and had significantly higher treatment failure rates (n = 24/92; 26.1% vs. n = 13/108; 12%; p = 0.02) compared to those without cholangitis. Independent risk factors for cholangitis included the presence of non-anastomotic strictures (OR 3.1), and first-time ERCP intervention with sphincterotomy (OR 6.31).
Post-ERCP cholangitis is a relevant complication of endoscopic treatment and is associated with the presence of non-anastomotic strictures and higher treatment failure rates. Since the success rate of endoscopic intervention in these complex strictures is limited, an optimized peri-interventional management and tailored antibiotic therapy may become particularly important for the further treatment and prognosis of these patients.
肝移植术后胆管狭窄与显著的发病率和死亡率相关。内镜逆行胰胆管造影术（ERCP）是首选的治疗方法。ERCP术后胆管炎是该手术的一种并发症。我们旨在评估移植后胆管狭窄患者中ERCP术后胆管炎的发生率、其对生存的影响，并确定潜在的危险因素。
这项回顾性研究评估了在特定间隔接受球囊扩张治疗的胆管狭窄肝移植受者。主要临床终点是ERCP术后胆管炎的发生率、总体生存率以及潜在危险因素的识别。
纳入了200例患者，中位随访期为6年（四分位间距2 - 10年）。分别在132例和68例患者中诊断出吻合口狭窄和非吻合口狭窄。总体而言，共进行了930次ERCP手术，其中148次手术（15.9%）检测到ERCP术后胆管炎。与无胆管炎的患者相比，ERCP术后胆管炎患者的总体生存率显著更差（中位生存期，9年对15年；对数秩检验，p < 0.001），非吻合口狭窄的诊断频率显著更高（44.6%对25%；p = 0.004），治疗失败率也显著更高（n = 24/92；26.1%对n = 13/108；12%；p = 0.02）。胆管炎的独立危险因素包括存在非吻合口狭窄（比值比3.1）以及首次进行括约肌切开术的ERCP干预（比值比6.31）。
ERCP术后胆管炎是内镜治疗的一种相关并发症，与非吻合口狭窄的存在和更高的治疗失败率相关。由于内镜介入治疗这些复杂狭窄的成功率有限，优化围介入期管理和量身定制的抗生素治疗对于这些患者的进一步治疗和预后可能尤为重要。
