Short fully covered self‐expandable metal stent for treatment of proximal anastomotic benign biliary stricture after living‐donor liver transplantation

Abstract

Objectives Non‐surgical methods have high success rates for treating benign biliary strictures (BBSs), but treatment of proximal strictures is difficult. Recent studies have reported that fully covered self‐expandable metal stents (FCSEMSs) are useful for treating refractory BBSs. We investigated the efficacy of a short and removable FCSEMS with an anti‐migration design for treatment of proximal BBSs. Methods Fully covered self‐expandable metal stents were inserted endoscopically in patients with BBSs after living donor liver transplantation (LDLT). Each FCSEMS was initially maintained for 3 months and subsequently exchanged every 3 months until the stricture resolved. Adverse events and stricture recurrence after FCSEMS removal were assessed during follow‐up. Results A total of 63 patients with a median age of 57 years were enrolled in this study; 50 were male. The most common underlying disease was hepatocellular carcinoma and the previous operation was LDLT. The mean duration from surgery to diagnosis of stricture was 8.5 months, and the mean stent indwelling time was 4.2 months. The technical success and stricture resolution rate were 100%. The recurrence rate was 23.8% and the adverse event rate was 12.7%. All stents were removable, and asymptomatic stent migration was observed in four patients (6.4%). Conclusions The newly designed FCSEMS is effective in the treatment of proximal BBSs after LDLT.

Endoscopic management of benign and malignant hilar stricture

“…To minimize segmental cholangitis and kinking, a “rescue” plastic stent was placed which reduced the rate of cholangitis and has now become routinely utilized for this purpose 35 . Another study by Jang et al 36 . similarly found that FCSEMS can be an effective treatment for hilar BBS with a 100% stricture resolution rate, 23% recurrence rate, 6.4% migration rate, and 100% retrievability.…”

Current endoscopic approaches to biliary strictures

“…Endoscopic stenting for perihilar BBS is technically demanding due to stricture location at the biliary tree bifurcation, severe angulation at the stricture, and thinner diameter of the intrahepatic bile duct [160–163,164 ▪ ]. Fully-covered SEMS is also a feasible option for this indication, although patient selection and institutional expertise are necessary for safe and effective treatment [165,166 ▪ ,167,168 ▪ ].…”

A Prospective Multicenter Study of “Inside Stents” for Biliary Stricture: Multicenter Evolving Inside Stent Registry (MEISteR)

“…Stents above the papilla, so-called "inside stents," have been investigated using both metal and plastic stents [9]. Fully-covered self-expandable metal stents (FCSEMS) with a retrieval lasso are increasingly utilized for benign biliary strictures at the hilum or anastomotic strictures [10][11][12][13], but FCSEMS is not always indicated in patients with nondilated ducts. Since introducing the concept of inside stents using plastic stents, there are some concerns about stent removal and exchange, too [14].…”