Effect of Covered Metallic Stents Compared With Plastic Stents on Benign Biliary Stricture Resolution

Coté, Gregory A.; Slivka, Adam; Tarnasky, Paul R.; Mullady, Daniel; Elmunzer, B. Joseph; Elta, Grace H.; Fogel, Evan L.; Lehman, Glen A.; McHenry, Lee; Romagnuolo, Joseph; Menon, Shyam; Siddiqui, Uzma D.; Watkins, James L.; Lynch, Sheryl; Denski, Cheryl; Xu, Huiping; Sherman, Stuart

doi:10.1001/jama.2016.2619

Cited by 200 publications

(196 citation statements)

References 20 publications

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“…According to a recent systematic review by Kao et al, the overall SEMS migration rate was 16% [94]. Interestingly, liver transplant patients are more likely to have stent migration than biliary strictures due to other benign causes [95]. Other factors likely to be associated with stent migration include a stricture close to the hilum, a large bile duct below the stricture, and a short stricture [95].…”

Section: Self-expandable Metallic Sent Placementmentioning

confidence: 99%

“…Interestingly, liver transplant patients are more likely to have stent migration than biliary strictures due to other benign causes [95]. Other factors likely to be associated with stent migration include a stricture close to the hilum, a large bile duct below the stricture, and a short stricture [95]. While stent migration occurred spontaneously without the need for further interventions in some cases [91], it could result in severe consequences [95].…”

Section: Self-expandable Metallic Sent Placementmentioning

confidence: 99%

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Endoscopic management of biliary strictures after living donor liver transplantation

Tsujino

Isayama

Kogure

et al. 2017

Clin J Gastroenterol

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Living donor liver transplantation (LDLT) is an effective alternative to deceased liver transplantation (DDLT) for end-stage liver disease. Although advances in surgical techniques, immunosuppressive management, and post-transplant care have improved the overall outcomes of LDLT, biliary strictures remain the major unsolved problem. Endoscopic retrograde cholangiopancreatography (ERCP) is currently considered the first-line therapy for biliary strictures following LDLT with duct-to-duct reconstruction, with percutaneous and surgical interventions reserved for patients with unsuccessful management via ERCP. Endoscopic management of biliary strictures is technically more challenging in LDLT than in DDLT because of the complexity of the biliary anastomosis, in addition to the tortuous and angulated biliary system. Placement of one or more plastic stents after balloon dilation has been the standard strategy for post-LDLT stricture, but this requires multiple stent exchange to prevent stent occlusion until stricture resolution. Inside stents might prevent duodenobiliary reflux and thus have longer stent patency, obviating the need for multiple ERCPs. Newly developed covered self-expandable metallic stents with anti-migration systems are alternatives to the placement of multiple plastic stents. With the advent of deep enteroscopy, biliary strictures in LDLT patients with Rouxen-Y hepaticojejunostomy are now treatable endoscopically. In this review, we discuss the short-and long-term outcomes of endoscopic management of post-LDLT strictures as well as recent advances in this field.

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Section: Self-expandable Metallic Sent Placementmentioning

confidence: 99%

Section: Self-expandable Metallic Sent Placementmentioning

confidence: 99%

Endoscopic management of biliary strictures after living donor liver transplantation

Tsujino

Isayama

Kogure

et al. 2017

Clin J Gastroenterol

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“…Percutaneous intervention is usually performed under ultrasound or radiological guidance, including abscess drainage, transhepatic biliary drainage, dilation of bile duct strictures and stent placement to maintain ductal patency, as well as management of complications from previous interventions. Although a randomized clinical trial showed that metallic stents should be considered an appropriate option in patients with benign biliary strictures and a bile duct diameter 6 mm or more (11). However, our experience does not recommend the use of metallic stents for biliary strictures in BDI patients because it does not improve the onset of recurrent cholangitis.…”

Section: Discussionmentioning

confidence: 68%

Management for a complicated biliary stricture after iatrogenic bile duct injury

et al. 2017

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Bile duct injury (BDI) remains to be a serious complication of biliary surgery. Biliary stricture is likely to occur in cases without proper management of BDI, may be causing such severe complications as repeated strictures, cholangitis or impairment to liver function. Here, we reported a 69-year-old man with a one-more-year history of recurrent cholangitis caused by iatrogenic BDI. The patient underwent a reconstruction of choledochojejunostomy, with liver quadrate lobectomy, and hilar cholangioplasty. The procedure was difficult, but the recovery was smooth. Only through comprehensive pre-operative evaluation and meticulous intraoperative manipulate, the technical challenge of re-operation for complicated biliary stricture after BDI should be easily addressed. cholangiopancreatography (MRCP) and computed tomographic angiography of the liver and biliary tract. MRCP showed stricture at hilar bile duct and dilatation of intrahepatic bile duct (Figure 1). Following a thorough discussion of treatment options and associated benefits and risks with the patient, we decided to proceed with a reconstruction of choledochojejunostomy. Risks and complications of the procedure included biliary leak, cholangitis, bleeding, anastomotic strictures, biliary cirrhosis, and the need for further surgeries. Pre-operative preparationPrior to the procedure, complete blood count, liver function test, coagulation function test, and cardiopulmonary function assessment were ordered (all normal) in addition to a full physical examination and patient history. Antibiotics were administered in that sequence no more than 30 minutes prior to the incision. Appropriate consent was obtained from the patient per our institutional protocol.Equipment preference card   Water knife;  Bile duct probes;  Fine catheter;  4-0 Vicryl suture;  5-0 Prolene suture;  Self-retaining wound retractor. ProcedureThe operative procedure is demonstrated in Figure 2. The patient was placed in the supine position. After general anesthesia was induced, a Foley catheter was placed. Through the original incision, a down L-shaped incision below the right rib edge was made. Dense adherence was found in the area of biliary-enteric anastomosis, which was 40 cm away from enteric-enteric anastomosis. Part of the right and quadrate lobe of liver (about 4 cm × 4 cm) was marked and removed. Then, bile duct above the anastomosis was separated by water knife. After finding the original anastomosis, the bile duct was confirmed by a puncture. Part of the anterior wall of the bowel was incised. Anastomotic scar hyperplasia was significantly associated with stenosis. It was found that left and right hepatic was interrupted, and anastomosis of left hepatic duct almost closed.Bile duct wall was separated from the liver tissue until opening the diameter of right hepatic duct to 2 cm, and the left to 2.5 cm. Due to the confluence of left and right hepatic duct to be adhered scar tissue, it was reshaped into an "8" shape with satisfaction. After exploration of the bile duct ...

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“…63 A recent prospective randomized controlled trial (PRCT) comparing FCSEMS to multiple plastic stents for benign biliary strictures reported a low PEP (5%); more than 90% of the patients underwent or had prior biliary sphincterotomy at time of randomization. 64 There does not appear to be an increased risk of PEP in patients with malignant biliary obstruction treated with FCSEMS even without biliary sphincterotomy. 65 This may be relevant; however, only in patients with pancreatic cancer who are known to be at low risk for PEP.…”

Section: Procedures Factorsmentioning

confidence: 93%

Endoscopic retrograde cholangiopancreatography complications: Techniques to reduce risk and management strategies

Tarnasky

Kedia

2017

Int J Gastrointest Interv

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Adverse events after endoscopic retrograde cholangiopancreatography (ERCP) are not uncommon and can be associated with tragic outcomes. Bleeding, perforation, and post-ERCP pancreatitis are the most common complications. Some events are unavoidable; others are associated with well described risk factors so that they can be either anticipated and/or measures can be taken for prevention or at least risk reduction. This review will focus on the more common complications after ERCP, their risk factors, and potential strategies for risk reduction. Additionally, recommendations for management of ERCP complications will be presented.

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Effect of Covered Metallic Stents Compared With Plastic Stents on Benign Biliary Stricture Resolution

Cited by 200 publications

References 20 publications

Endoscopic management of biliary strictures after living donor liver transplantation

Endoscopic management of biliary strictures after living donor liver transplantation

Management for a complicated biliary stricture after iatrogenic bile duct injury

Endoscopic retrograde cholangiopancreatography complications: Techniques to reduce risk and management strategies

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