The presence and outcome of biliary sphincter disorders in liver-transplant recipients according to the Rome IV classification

基于罗马Ⅳ标准的肝移植患者胆管括约肌疾病的发生率和临床结局

Background Biliary sphincter disorders after liver transplantation(LT)are poorly described.We aim to describe the presence and outcome of patients with papillary stenosis(PS)and functional biliary sphincter disorders(FBSDs)after LT according to the updated Rome IV criteria.Methods We reviewed all endoscopic retrograde cholangiopancreatographies(ERCPs)performed in LT recipients between January 2003 and December 2019.Information on clinical and endoscopic findings was obtained from electronic health records and endoscopy databases.Laboratory and clinical findings were collected at the time of ERCP and 1 month after ERCP.Results Among the 1,307 LT recipients,336 underwent 849 ERCPs.Thirteen(1.0%)patients met the updated Rome IV criteria for PS[former sphincter of Oddi dysfunction(SOD)type I]and 14 patients(1.0%)met the Rome IV criteria for FBSD(former SOD type II).Biliary sphincterotomy was performed in 13 PS and 10 FBSD cases.One month after sphincterotomy,bilirubin,gamma-glutamyl transferase and alkaline phosphatase levels decreased in 85%,61%,and 92%of those in the PS group(P¼0.019,0.087,and 0.003,respectively)and in 50%,70%,and 80%of those in the FBSD group(P¼0.721,0.013,and 0.093,respectively).All the 14 patients initially suspected of having a FBSD turned out to have a different diagnosis during the follow-up.Conclusions PS after LT is uncommon and occurs in only 1%of LT recipients.Our data do not support the presence of an FBSD after LT.Sphincterotomy is a safe and effective procedure in LT recipients with PS.

背景:目前对肝移植患者胆管括约肌疾病的认识严重不足。本研究旨在描述基于最新修订的罗马Ⅳ标准,肝移植患者乳头狭窄(PS)和胆管括约肌功能障碍(FBSD)的发生率和临床结局。方法:筛选2003年1月至2019年12月间接受内镜逆行性胆胰管造影(ERCP)的肝移植患者,从电子病历和内镜数据库中提取其临床资料及内镜发现,并收集ERCP检查时及ERCP术后1个月的实验室检查结果和临床结局。结果:在1,307例肝移植患者中,336例接受了849次ERCP。13例(1.0%)符合罗马Ⅳ的PS诊断标准[既往称为Oddi括约肌功能障碍(ODS)Ⅰ型],14例(1.0%)符合FBSD诊断标准(既往称为SOD Ⅱ型)。13例PS患者和10例FBSD患者接受了胆管狭窄成形术,术后1个月,分别有85%、61%和92%的PS患者总胆红素(P=0.019)、γ谷氨酰转移酶(P=0.087)和碱性磷酸酶(P=0.003)下降,而在FBSD患者,上述指标下降的患者比例分别为50%(P=0.721)、70%(P=0.013)和80%(P=0.093)。所有最初疑似BFSD的14例患者在随访中均调整了最终诊断。结论:肝移植术后PS的发生并不常见,发生率仅1%。我们的数据并不支持肝移植术后FBSD的诊断。狭窄成形术治疗肝移植术后PS患者安全有效。