Objective To investigate the experience and effect of emergency endoscopic treatment for massive upper gastrointestinal bleeding (UGB) of patients after liver transplantation. Methods Clinical data of 3 patients with massive UGB after liver transplantation receiving emergency endoscopic treatment in Digestive Endoscopy Center, the Third Affiliated Hospital of Sun Yat-sen University from May 2012 to December 2013 were analyzed retrospectively. All the patients were male with the age of 44, 54 and 61 years old, and all had symptoms of haematemesis, massive melena and shock to various degrees. The informed consents of all patients were obtained and the ethical committee approval was received. The patients were prepared by fasting, supplementing blood volume, psychologically nursing before operation. And the endoscopic instruments, medicine and emergency rescue items were prepared. The patients were kept the airway clear, doctors and nurses well cooperated and the vital signs were closely observed. Clear endoscopic field was kept during the operation and appropriate hemostasis were performed according to different situations. The patients were sent back to bed-
ward after they were stable after the operation and were handed over to the attending physician meticulously. Results For case 1, hemostatic clips were used to stop the active bleeding from contralateral bare vessels on the horn of duodenal bulb and a local injection of sclerosing agent was given. For case 2, the COOK ligator was used to ligate the esophageal varices rupture to stop the active bleeding, and tissue glue was injected at the bleeding spots of severe gastric fundus varices. The bleedings in case 1 and 2 were stopped successfully. For case 3, the stomach was filled with masses of blood clots and dark red blood and still couldn't be visible after being repeatedly washed and drainage. Thus the patient was urgently transferred to undergo embolization of the bleeding artery. This patient died of pulmonary infection, hemorrhagic shock and cardiac insufficiency after the operation. Conclusions Preoperative preparation should be well made during the emergency endoscopic hemostasis in patients with massive UGB after liver transplantation, and well cooperation of doctors and nurses, close observation on patients' condition, clear endoscopic field, appropriate hemostasis are necessary for improving the outcome.

ObjectiveTo investigate the application value of endoscopic retrograde cholangiopancreatography (ERCP) in biliary stricture following liver transplantation (LT).MethodsClinical data of 47 patients with biliary stricture following LT treated with ERCP in the Third Affiliated Hospital of Sun Yat-sen University between January 2008 and January 2014 were retrospectively studied. The informed consents of all patients were obtained and the local ethical committee approval had been received. Among the 47 patients, 41 were males and 6 were females with the age ranging from 24 to 62 years old and the median of 51 years old. Anastomotic stricture was observed in 31 cases and non-anastomotic stricture in 16 cases. ERCP was performed on patients to localize biliary stricture and then papillotomy was performed under the support of guide wire. The stricture was dilated progressively by dilating catheter or columnar balloon through the guide wire. Endoscopic nasobiliary drainage or plastic stent placement was chosen according to the ERCP results. The evaluation of curative effect was graded by cure, improvement, inefifcacy and restenosis.ResultsAll the 47 patients underwent ERCP successfully with totally 112 times. Nasobiliary drainage was performed 79 person-times, stent placement 33 person-times. Among the 31 patients with anastomtic stricture, 28 were cured and 3 were improved. Among the 16 patients with non-anastomtic stricture, 5 were cured, 3 were improved, and 8 were ineffective. The total cured rate of all the patients was 70% (33/47) and the effective rate was 83% (39/47). The incidence of complications was 9% (4/47), including 2 cases of mild pancreatitis, 1 case of hyperamylasemia and 1 case of biliary tract infection.ConclusionERCP is safe, effective and integrated in diagnosis and treatment for biliary stricture following LT, which is the ifrst choice for non-surgery treatment.