Biliary strictures in liver transplant recipients: treatment with metal stents.

Culp, William C.; McCowan, Timothy C.; Lieberman, Robert P.; Goertzen, Timothy C.; LeVeen, Robert F.; Heffron, Thomas G.

doi:10.1148/radiology.199.2.8668775

Cited by 80 publications

(61 citation statements)

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“…Prophylaxis with shortterm systemic antibiotics is reported to prevent septic complications effectively. 20,24 We did not experience other serious complications such as subcapsular hematoma of the liver, bleeding, or hemobilia and acute pancreatitis, as reported by others. 26 Review of the literature.…”

Section: Choice In Treatment Of Bssupporting

confidence: 69%

Long-term results of percutaneous management for anastomotic biliary stricture after orthotopic liver transplantation

Roumilhac

Poyet

Sergent

et al. 2003

Liver Transplantation

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The purpose of this study was to evaluate the results of percutaneous transhepatic management (PTM) of anastomotic biliary strictures (BS). Among 168 liver transplant adult recipients, BS was identified in 30 patients. In 6 patients, narrowing of the anastomosis was found early, and in all cases disappeared spontaneously with prolonged draining of the bile tube. Within a mean time of 14 months after transplantation, 24 patients had symptomatic BSs, revealed by cholestasis (n ‫؍‬ 17) or cholangitis (n ‫؍‬ 7). Twenty-two patients underwent PTM as first treatment of BS (balloon dilatation or stent placement). We evaluated the primary and secondary patency rate of PTM. In 1 patient, PTM failed because the stricture could not be passed with the guide wire, necessitating conversion to a Roux-en-Y choledochojejunostomy (CDJ). Fourteen patients were treated by percutaneous balloon dilatation from which 8 patients (57.2%) were recurrence-free with a mean follow-up of 61 months. One patient with a patent biliary anastomosis underwent retransplantation for acute rejection. Twelve patients received metallic expandable stent placement as their primary treatment (n ‫؍‬ 7) or after failure of balloon dilatation (n ‫؍‬ 5). Recurrent stricture was found in 7 cases (58%) and was treated by PTM (n ‫؍‬ 6) or surgery (n ‫؍‬ 1). The primary patency rate for PTM was 58.8% at 12 months and the secondary patency rate 88.4%, with a mean follow-up of 47 months (median: 44 months). The mortality rate was 3.5% (one death). PTM with balloon dilatation, stent placement, or both, represent a safe method to treat anastomotic BSs after orthotopic liver transplantation (OLT) resulting in a secondary patency rate of 88% at 5 years. (Liver Transpl 2003;9:394-400.) P reviously biliary complications after orthotopic liver transplantation (OLT) have been reported as a perioperative and a middle long-term event in 10% to 40% of patients 1-3 and even nowadays remain an important cause of morbidity after the surgical procedure. 4 Biliary strictures (BS) are reported to occur in 9% to 15% of adult OLT recipients with choledochojejunostomy (CDJ) or choledochocholedochostomy (CDC) and are frequently localized at the anastomosis. 2,5-7 BSs appear also to be a problem in living related liver transplantation. [8][9][10] However, the management of these BSs remains controversial. In a recent survey, 22% of transplant centers in United States reported the use of percutaneous transhepatic management (PTM), whereas 29% chose reoperation and 45% used endoscopic retrograde cholangiography (ERCP). 11 Considering the potential risks of surgical reintervention, we decided in 1990 to treat BSs with PTM as a first approach. The objectives of this retrospective study were to evaluate the longterm outcome and results of systematic PTM for anastomotic BS after OLT. Patients and MethodsBetween July, 1987 and December, 2000, 216 consecutive OLT were performed in our center. To evaluate the middleand long-term outcome of BS, 168 adult patients (85 male and 83 female, age 15 t...

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Section: Choice In Treatment Of Bssupporting

confidence: 69%

Long-term results of percutaneous management for anastomotic biliary stricture after orthotopic liver transplantation

Roumilhac

Poyet

Sergent

et al. 2003

Liver Transplantation

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“…31 The migration of self-expandable metal stents occurs rarely, with a frequency of less than 1%, because the surrounding tissue grows through the interstices of the stent and produces fixation, although the same process is believed to lead to occlusion eventually. [32][33][34][35] It is also believed that the shortening that occurs following placement aids security. 36 The significantly more frequent migration of plastic stents at approximately 10% 17,32,34,37,38 led Johanson et al 17 to analyse various stent characteristics and clinical factors that may contribute to proximal and distal stent migration.…”

Section: Discussionmentioning

confidence: 99%

“…16,39 It has also been noted that distal migration of stents is more common in benign than malignant strictures. 16,17,33,[40][41][42] The possible explanation for this phenomenon being that benign stenosis is less tight, due to resolution of inflammation and mucosal oedema and also that the tumour growth in malignant strictures may help to anchor the stent and prevent migration. 32 Arhan et al, 21 however, reported that stent migration is less frequent following treatment of strictures following cholecystectomy compared to other benign aetiologies possible due to the tight fibrotic nature of these strictures.…”

Section: Discussionmentioning

confidence: 99%

A review of problems following insertion of biliary stents illustrated by an unusual complication

Bagul

Pollard

Dennison

2010

annals

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Introduction The management of obstructive jaundice resulting from both benign and malignant causes relies heavily on minimally invasive techniques and particularly with the insertion of biliary endoprostheses. Migration of these biliary stents is a well-documented problem and can result in a variety of complications including perforation, intra-abdominal sepsis, fistulae formation, obstruction and appendicitis. Methods A literature search was performed using PubMed examining case reports, published abstracts and reviews to date (2009). In addition, we report a left groin abscess as a previously unreported complication following migration of a biliary endoprosthesis. Findings Stent migration can lead to serious complications and produce significant morbidity and mortality. Symptomatic patients especially those with other co-morbid abdominal pathologies such as colonic diverticulae, parastomal hernia or abdominal hernias may be at an increased risk of perforation especially when straight plastic stents are used.

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“…Penetration requires adherence between the perforated and the penetrated organ, and does not induce intra-abdominal contamination, but eventually causes fistulae (i.e., interenteric or biliocolic [36] , colovaginal [25] or colovesicular [27] ). Downstream migration is more frequent in benign than in malignant biliary duct strictures [9,35] . Benign stenoses are not as tight because of regression of inflammatory reactions after placement of the stent.…”

Section: Discussionmentioning

confidence: 99%

Complications and treatment of migrated biliary endoprostheses: A review of the literature

Namdar

Raffel²,

Topp³

et al. 2007

WJG

104

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Endoscopic biliary stent insertion is a well-established procedure. It is especially successful in treating postoperative biliary leaks, and may prevent surgical intervention. A routine change of endoprostheses after 3 mo is a common practice but this can be prolonged to 6 mo. We reported a colonic perforation due to biliary stent dislocation and migration to the rectosigmoid colon, and reviewed the literature.

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Biliary strictures in liver transplant recipients: treatment with metal stents.

Abstract: Metal stents can be useful in the short term but have limited patency, often require repeat intervention, and have substantial complications. Long-term success depends heavily on repeat interventions or stent removal.

Cited by 80 publications

References 0 publications

Long-term results of percutaneous management for anastomotic biliary stricture after orthotopic liver transplantation

Long-term results of percutaneous management for anastomotic biliary stricture after orthotopic liver transplantation

A review of problems following insertion of biliary stents illustrated by an unusual complication

Complications and treatment of migrated biliary endoprostheses: A review of the literature

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