Metal versus plastic stents for anastomotic biliary strictures after liver transplantation: a randomized controlled trial

Martins, Fernanda P.; Paulo, Gustavo Andrade de; Contini, M; Ferrari, Ângelo Paulo

doi:10.1016/j.gie.2017.04.013

Cited by 92 publications

(150 citation statements)

References 27 publications

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“…Because they are readily removed from the bile duct during ERCP [90], covered SEMS are more appropriate for benign biliary strictures. In two recent RCTs of covered SESM versus multiple PSs for biliary strictures after DDLT, stricture resolution rates were similar, but covered SEMS required significantly fewer ERCPs to resolve the strictures [91,92].…”

Section: Self-expandable Metallic Sent Placementmentioning

confidence: 99%

“…Another problem is duodenobiliary reflux when placing a large-diameter covered SEMS across the papilla, which disturbs the physiological status of the biliary system. In addition, EST is required to prevent post-ERCP pancreatitis prior to covered SEMS placement [92], resulting in loss of sphincter of Oddi function [70,71].…”

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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“…This was a multicenter, prospective, non‐randomized clinical trial at four tertiary referral hospitals performed from January 2013 to January 2017. The inclusion criteria were as follows: admitted patients who had clinical symptoms of bile duct obstruction with jaundice, those who had documented ABS after LDLT, and those who had persistent biliary stricture after at least one endoscopic treatment with plastic stent(s) with or without balloon dilatation. Exclusion criteria were as follows: those who were under 18 years old or over 80 years old, contradictions to ERCP, suspected malignant biliary stricture, surgically altered gastrointestinal anatomy, bleeding tendency (platelet < 50 000/mm 3 or prothrombin time international normalized ratio > 1.5), and those who refused to participate in this study.…”

Section: Methodsmentioning

confidence: 99%

“…Anastomotic biliary stricture (ABS) is one of the most common postoperative complications after liver transplantation (LT). Endoscopic retrograde cholangiopancreatography (ERCP) is considered the first option for relieving biliary obstruction in patients with ABS . In general, the use of plastic stent with or without balloon dilatation is a common and widely spread treatment.…”

Section: Introductionmentioning

confidence: 99%

“…First, stent migration can easily occur due to difficulty in placing the center of stent at the stricture. Second, bile duct injury and tissue hyperplasia can be induced by flared end and unnecessary long covering of distal bile duct of current FCSEMS having strong radial force . Last, duodenobiliary reflux from the wide opening of stent into the duodenum is also an important AE that can limit the patency of the stent.…”

Section: Introductionmentioning

confidence: 99%

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Intraductal placement of non‐flared fully covered metallic stent for refractory anastomotic biliary strictures after living donor liver transplantation: Long‐term results of prospective multicenter trial

Yoo

Lee

et al. 2019

J of Gastro and Hepatol

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Background and Aim Fully covered self‐expandable metallic stent (FCSEMS) may be an effective modality for managing anastomotic biliary stricture (ABS) after liver transplantation. However, stent migration and stent‐induced ductal injury are the main limitations. The objective of this study was to evaluate the usefulness of an unflared, intraductal FCSEMS that was designed to minimize migration and ductal injury for refractory ABS after living donor liver transplantation (LDLT). Methods A total of 32 consecutive patients with symptomatic ABS after LDLT unresolved by plastic stents with or without balloon dilation at four tertiary medical centers were prospectively enrolled. A short (3 or 5 cm) FCSEMS having long lasso (10 cm) used in this study had unflared convex ends to minimize tissue hyperplasia and smaller center portion to prevent migration. The FCSEMS was placed above the papilla and removed at 3–4 months after stenting. Results Technical and clinical success rates of intraductal placement with FCSEMS were 100% (32/32) and 81.2% (26/32), respectively. Early stent migration was observed in five (15.6%) patients. However, three patients with early stent migration had stricture resolution without needing additional intervention. Intended stent removal was successful in 27 (100%) patients (median, 101 days; range, 23–118 days). No stent‐induced ductal change was observed in all patients. Stricture recurrence was observed in 11.5% (3/26) of patients during 639 days of median duration of follow‐up (range, 366–2079 days). Conclusions Intraductal placement of an unflared short FCSEMS may be a promising option for refractory ABS after LDLT with minimal stent‐induced ductal injury and stent migration.

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Fully covered metallic stents for anastomotic biliary strictures after living donor liver transplantation

et al. 2023

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Objectives Anastomotic biliary strictures (ABSs) are common complications following living donor liver transplantation (LDLT). We evaluated the feasibility of a novel removable, intraductal, fully covered, self‐expandable metallic stent (FCSEMS) for the treatment of ABSs following LDLT. Methods Nine patients with duct‐to‐duct ABSs that developed following LDLT were prospectively enrolled in this study. We placed a short FCSEMS with a long lasso and middle waist formation in each patient's ABS above the papilla and removed it 16 weeks later. Results The FCSEMS placements were successful in all nine cases. Four patients experienced mild cholangitis, which was resolved with conservative treatment. Additionally, there was one case of distal migration. The FCSEMSs were successfully removed from all the patients, and the clinical success rate was 100%. Stricture recurrence occurred in one (11.1%) patient during the follow‐up period. Limitations The small number and lack of comparison with other types of FCSEMSs and plastic stents. Conclusions Intraductal placement of FCSEMSs is useful for treating refractory ABSs after LDLT, although further studies are required with larger sample sizes.

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Metal versus plastic stents for anastomotic biliary strictures after liver transplantation: a randomized controlled trial

Cited by 92 publications

References 27 publications

Endoscopic management of biliary strictures after living donor liver transplantation

Endoscopic management of biliary strictures after living donor liver transplantation

Intraductal placement of non‐flared fully covered metallic stent for refractory anastomotic biliary strictures after living donor liver transplantation: Long‐term results of prospective multicenter trial

Fully covered metallic stents for anastomotic biliary strictures after living donor liver transplantation

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