Taha Qazi, MD: Bleeding Risk with Early Versus Late ERCP Following Liver Transplant

Biliary complications, most commonly strictures and leaks, are a frequent source of morbidity following liver transplantation. Endoscopic retrograde cholangiopancreatography (ERCP) often serves as the first line of therapy for post-transplant biliary complications, but outcomes of ERCP in early as compared to late liver transplant period are not well understood.

The seventh issue of Qazi Corner, a collaborative quarterly newsletter on gastroenterology research, news, and trends between HCPLive and editor-in-chief Taha Qazi, MD, spotlights a study exploring the safety and outcomes of ERCP for post-liver transplant biliary complications based on how early or late the procedure is done after transplantation. Specifically, the study labels ERCP within 30 days post-transplant as early and anything beyond 30 days as late.

“Oftentimes we've been sort of have this push to do quick, quick, quick, quick, as much as we can,” Qazi said. “So, sometimes we have to take a step back and sort of ask, after liver transplantation, specifically in these patients, what is the best time to do an endoscopic retrograde cholangiopancreatography, or ERCP. In most patients, we didn’t know this data.”

The single-center retrospective review compared complications between ERCP performed more than and less than 30 days post-transplant. Results showed greater rates of early post-procedural bleeding when an ERCP was performed less than 30 days after liver translation compared with an ERCP that was performed more than 30 days post-transplant, but with similar technical and clinical success regardless of timing.

Acknowledging certain situations and indications where it may not be possible to delay ERCP, Qazi emphasized the potential benefit of doing so where applicable, saying “The understanding is that a procedure that can be delayed if possible, may be safer for the patient, although we're still looking into that understanding.”

Dr. Rajat Garg’s article: Safety, Outcomes of Early Versus Late ERCP in Liver Transplant Recipients