Fully covered metallic stents in biliary stenosis after orthotopic liver transplantation

Abstract

For endotherapy of biliary complications after orthotopic liver transplantation, metallic stents should not be used as the primary modality. In patients in whom the standard approach fails, treatment with temporary SEMS placement can solve biliary complications in almost three-quarters of cases; however stent migration(33 %) remains a problem.

Definitive outcomes of self-expandable metal stents in patients with refractory post-transplant biliary anastomotic stenosis

“…Early studies in partially covered stents and FCSEMS for benign biliary strictures have been positive [5][6][7]. There have been several studies of FCSEMS in benign biliary strictures indicating good stricture resolution rates [7][8][9][10].…”

“…Compared with a multiple plastic stents, the potential benefits of a single FCSEMS are in its relative simplicity and the need for only two ERCP procedures, one for insertion and the other for removal. Multiple case series have been published using such stents after liver transplantation, with generally good outcomes [6,8,[11][12][13].…”

Benign Biliary Strictures and Leaks

“…They could provide more ample and prompt dilation than plastic stents and eliminate the need for multiple sequential ERCP stent exchanges and their attendant costs. 25,26 A recent multicentric study 27 confirmed the primary requisite of these stents, that is, removability in all cases (with, however, the need for more than 1 procedure in 5%), and showed that a 6-month indwell was able to provide stricture resolution in approximately 70% of patients with postcholecystectomy or anastomotic post-OLTx strictures. These results are surely not better than those reported with multiple plastic stents in these indications, a feature probably related to the high spontaneous migration rate of FCSEMS (around 17% in both groups).…”

Endoscopic approach to benign biliary obstruction

“…23 Furthermore reported cases of postcholecystectomy biliary strictures treated with FC-SEMS are very rare (Table 1). 17,[24][25][26][27][28] Anastomotic biliary strictures following liver transplantation…”

“…33 FC-SEMS have been proposed to dilate anastomotic strictures following OLT because their removability was safe and possible in almost all cases; results are still under evaluation due to the high incidence of stents migration and the high stricture recurrence rate at the 2-year follow-up (Table 3). 26,28,47,48 Biliary strictures secondary to chronic pancreatitis Chronic pancreatitis (CP) is an inflammatory process characterized by destruction of pancreatic parenchyma and ductal structures with subsequent formation of fibrosis. 49 Strictures of the common bile duct (CBD) can be found in 3-46% of patients with advanced CP.…”