The role of ERCP in patients with pancreatico-biliary problems in the setting of hematopoietic stem cell transplant

Background: Patients undergoing hematopoietic stem cell transplant may develop pancreatico-biliary complications that may require ERCP. Due to their immunocompromised state, these patients may be at higher risk of procedure-related complications. Objective: To determine the role of ERCP in the diagnosis and treatment of patients who have undergone hematopoietic stem cell transplant and the patients' clinical outcomes. Design: Retrospective analysis of patients with hematopoietic stem cell transplant who underwent ERCP from 1997 to 2004 evaluating ERCP indications, diagnosis, therapeutic interventions, and complications. Setting: Tertiary referral center. Results: Of the 16 patients identified, 9 were female, 15 had had allogeneic hematopoietic stem cell transplant, and 1 had an autologous hematopoietic stem cell transplant. Twenty-six ERCP procedures were performed in the 16 patients. Index ERCP findings included: extra hepatic bile duct obstruction in 12 patients, of which 7 had biliary lithiasis. Ampullary obstruction due to infiltration from graft versus host disease was seen in 3 of 12 patients, benign bile duct stricture in 1 of 12, and ampullary obstruction in the setting of a peri-ampullary diverticulum in 1 of 12. Index ERCP findings in the remaining 4 patients included: intrahepatic bile duct compression due to metastatic disease in 1 of 16 patients, bile duct leak in 1 of 16, pancreatic duct stone in 1 of 16, and normal ERCP in 1 of 16. Complications occurred in 4 patients: mild pancreatitis (1), mild bleeding (1), cholangitis due to late stent occlusion (1), and intermittent bradycardia (1). There were no ERCP-related deaths. Limitations: Single-center study. Conclusion: In patients with hematopoietic stem cell transplant, bile duct lithiasis was the most common finding at ERCP, followed by obstructive ampullary tissue infiltration due to graft versus host disease. ERCP yielded clinically relevant information in this particular group of patients. Copyright © 2006 by the American Society for Gastrointestinal Endoscopy.