Self Expandable Metal Stents for Anastomotic Stricture Following Liver Transplant

Cerecedo-Rodriguez, Jorge; Phillips, Melissa S.; Figueroa-Barojas, Paola; Kumer, Sean C.; Gaidhane, Monica; Schmitt, Timothy M.; Kahaleh, Michel

doi:10.1007/s10620-013-2703-0

Cited by 19 publications

(23 citation statements)

References 31 publications

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“…A recent study using retrievable covered stent showed a success rate of 60–70% for anastomotic strictures in DDLT. [25] Another study showed that retrievable covered stent has patency rate of 100% and plastic stents has patency rate of 80% in the treatment of anastomotic strictures after DDLT [Figure 5]. The main limitations of using metallic stents are stent migration, and early reocclusion.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous transhepatic techniques for management of biliary anastomotic strictures in living donor liver transplant recipients

Kulkarni

Prabhu

Kader

et al. 2017

Indian Journal of Radiology and Imaging

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Aim:To retrospectively analyze the percutaneous transhepatic techniques and their outcome in the management of biliary strictures in living donor liver transplant (LDLT) recipients.Materials and Methods:We retrieved the hospital records of 400 LDLT recipients between 2007 and 2015 and identified 45 patients with biliary strictures. Among them, 17 patients (37.8%) (Male: female = 13:4; mean age, 36.1 ± 17.5 years) treated by various percutaneous transhepatic biliary techniques alone or in combination with endoscopic retrograde cholangiopancreatography (ERCP) were included in the study. The technical and clinical success of the percutaneous management was analyzed.Results:Anastomotic strictures associated with leak were found in 12/17 patients (70.6%). Ten out of 12 (83.3%) patients associated with leak had more than one duct-duct anastomoses (range, 2–3). The average duration of onset of stricture in patients with biliary leak was 3.97 ± 2.68 months and in patients with only strictures it was 14.03 ± 13.9 months. In 6 patients, endoscopic-guided plastic stents were placed using rendezvous technique, plastic stent was placed from a percutaneous approach in 1 patient, metallic stents were used in 2 patients, cholangioplasty was performed in 1 patient, N-butyl- 2-cyanoacrylate embolization was done in 1 child with biliary-pleural fistula, internal-external drain was placed in 1 patient, and only external drain was placed in 5 patients. Technical success was achieved in 12/17 (70.6%) and clinical success was achieved in 13/17 (76.5%) of the patients. Posttreatment mean time of follow-up was 19.4 ± 13.7 months. Five patients (29.4%) died (two acute rejections, one metabolic acidosis, and two sepsis).Conclusions:Percutaneous biliary techniques are effective treatment options with good outcome in LDLT patients with biliary complications.

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Section: Discussionmentioning

confidence: 99%

Percutaneous transhepatic techniques for management of biliary anastomotic strictures in living donor liver transplant recipients

Kulkarni

Prabhu

Kader

et al. 2017

Indian Journal of Radiology and Imaging

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“…The accompanying paper adds to the hesitation in the use of FCSEMS as a first-line therapy [4]. Therefore, alternatives should be considered.…”

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confidence: 99%

“…FCSEMS are a good first choice because of their easy removal and long duration of patency due to lack of tissue hyperplasia and implantation into the biliary tree. Since frequent spontaneous stent migration is a major adverse event associated with FCS-EMS, an anchoring system such as flared ends or anchoring fins has been developed [3].In this issue of Digestive Diseases and Sciences, Kahaleh's group reports the retrospectively analyzed outcomes of covered SEMS for 55 patients with anastomotic strictures after LT [4]. Twenty-seven of 55 (49.1 %) patients were treated with plastic stents prior to covered SEMS.…”

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Covered Self-Expandable Metal Stents for the Treatment of Benign Biliary Strictures After Liver Transplantation: When and How?

Lee

2013

Dig Dis Sci

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Benign biliary strictures (BBS) may complicate biliary surgery including liver transplantation (LT) [1]. The firstline management of BBS, including anastomotic strictures after LT, now incorporates endoscopic therapy, mostly consisting of stenting [2]. Although originally designed for endoscopic palliation of malignant biliary strictures, the self-expandable metallic stent (SEMS) is a valid alternative to surgery for BBS. Patients with malignant biliary strictures who undergo treatment with metal stents have a limited life expectancy due to the poor prognosis of the underlying disease. Therefore, for patients with BBS who have a normal life expectancy, the indications for metal stent placement should differ from those applied to malignant biliary strictures.Metal stents can be divided into uncovered SEMS, partially covered SEMS, and fully covered SEMS (FCS-EMS). Non-removable uncovered SEMS cannot be used for BBS due to their limited patency, since reactive hyperplastic tissue may extend through the metal mesh. Partially covered SEMS can be used for BBS to decrease the rate of stent migration; however, the uncovered portion can embed in the bile duct wall. FCSEMS are a good first choice because of their easy removal and long duration of patency due to lack of tissue hyperplasia and implantation into the biliary tree. Since frequent spontaneous stent migration is a major adverse event associated with FCS-EMS, an anchoring system such as flared ends or anchoring fins has been developed [3].In this issue of Digestive Diseases and Sciences, Kahaleh's group reports the retrospectively analyzed outcomes of covered SEMS for 55 patients with anastomotic strictures after LT [4]. Twenty-seven of 55 (49.1 %) patients were treated with plastic stents prior to covered SEMS. The authors applied three different types of covered SEMS: partially covered SEMS (19 patients), FCSEMS with anchoring fins (21 patients), and FCSEMS with flared ends (15 patients). Endoscopic biliary sphincterotomy was performed in all patients. Although the authors endeavored to center the stent within the stricture, success was not universal. All covered SEMS were removed after 3-4 months. The technical success rate was 100 %, but the clinical success rate, as measured by stricture resolution, was unsatisfactory (60-74 %). Even after covered SEMS placement, three (5.5 %) patients eventually required surgery to resolve their biliary strictures. Notably, the stentrelated adverse event rate involving migration and occlusion was 7-24 %. Five patients with early stent occlusion required repeat stenting. Indeed, the clinical success rate of endoscopic stenting with multiple plastic stents is reportedly 87-94 % [5].The location of the stricture is usually the most proximal aspect of the common hepatic duct in anastomotic strictures after LT, especially after living-related LT recipients, in whom the strictured segment is usually short. To achieve effective stenting with covered SEMS, the stent should be centered within the strictured bile duct segment, which ...

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“…Whereas the utility of endotherapy in the adult population is well documented, data are limited for similar interventions in the cohort of pediatric patients with liver transplants [3]. The placement of a fully covered self-expanding metal stent is an emerging modality for the treatment of refractory biliary strictures following liver transplant [4]. However, there are no documented reports in pediatric patients with liver transplants.…”

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Resolution of post-liver transplant anastomotic biliary stricture with successful placement of a self-expanding metallic stent in a child

et al. 2015

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Self Expandable Metal Stents for Anastomotic Stricture Following Liver Transplant

Abstract: The observed clinical success rate of CSEMS (70.4%) proved to be below the reported one for multiple plastic stents, while no significant differences between CSEMS types were observed.

Cited by 19 publications

References 31 publications

Percutaneous transhepatic techniques for management of biliary anastomotic strictures in living donor liver transplant recipients

Percutaneous transhepatic techniques for management of biliary anastomotic strictures in living donor liver transplant recipients

Covered Self-Expandable Metal Stents for the Treatment of Benign Biliary Strictures After Liver Transplantation: When and How?

Resolution of post-liver transplant anastomotic biliary stricture with successful placement of a self-expanding metallic stent in a child

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