Therapeutic ERCP for the liver transplantated situations and hepatobiliary malignancy
Narantsatsralt J. , MD, UBSD
Battulga A. , MD, UBSD
Bolor O. , MD, UBSD
Seoul Songdo Clinic
T. Tserentogtokh, MD 3rd central hospital
D. Alimaa, chief nurse of endoscopy department
D. Davaadorj MD, PhD UBSD
Ulaanbaatar
Backround
Introduction
ERCP was performed the first time in Mongolian UBSD hospital in July 2009 by a team of doctors from UBSD Hospital under the guidance of Shim Chan Sob endoscopy doctor of Konkuk University Hospital of Korea.
Methods
From the 2010 a team of our doctors performed the ERCP without supervision at Ulaanbaatar Song Do. And until June 2014 performed 301 successfully cases.
Complication of ERCP
- 2 cases were complicated Cholangitis after ERCP.
- Duodenal perforation- 1
- Bile duct injure — 1/liver transplantation patient/
- Bleeding after EST — 4
- Pancreatitis‑5
- Mortality‑0
| Biopsy or brush cytology | Applicable biopsy results | |||
| 1 | Pancreatic head mass | 35 | 17 | 4 |
| 2 | CBD mass lesion | 5 | 5 | 3 |
| 3 | Ampular mass lesion | 6 | 6 | 5 |
| 4 | External compression of the CBD due to cancer metastasis |
4 | 0 | 0 |
| 5 | Liver cancer metastasis in the mid CBD | 1 | 1 | 1 |
| 6 | Hilar mass/klathkins tumor/ | 2 | 1 | 1 |
Performed ERCP 53 patients of the malignant obstruction with the Biliary and pancreatic ducts.
SEMS insertion were 2 patiens. Others were plastic stents and ENBD. Biopsy and brush cytology result was 50 %. After the ERCP jaundice and other complications decreased. 4 patients had successfully Whipple procedure after ERCP on NCC of Mongolia and Korean hospitals. Post liver transplantation patients were 6. Typical anastomotic stenosis was one case with good result of the ERCP. Others were non anastomotic jaundice.
Known HCC patient with jaundice Biopsy done from mid CBD soft mass and Result: Hepatocelular carcinoma
- Patient had living donor transplantation. Jaundice and segmental narrowing noted around the anastomosis after 6 months
- Balloon dilation and plastic stent insertion done on the stricture with good result.
Conclusion
- The incidence of the obstructive jaundice high in our country and advance of the ERCP is necessary.
- Routine use of prophylactic antibiotics in elective ERCP is controversial. The infectious risks of ERCP (ie, bacteremia and cholangitis) are most likely to occur in patients who present with biliary obstruction.
- A policy of selective outpatient therapeutic ERCP, with admission reserved for those with established or suspected complication, appears to be safe and reduces health care costs.
