title: Treatment of post liver transplantation bile duct stricture with self-expandable metallic stent.
abstract: OBJECTIVE
  The aim of this study is to report our experience using self-expandable covered metallic stents (Wallstent) to treat different types of biliary strictures after orthotopic liver transplantation (OLT).
  
  
  METHODS
  Between January 1999 and July 2004, 222 OLTs were performed with choledocho-choledochostomy (CC) bile duct reconstruction. An anastomotic biliary stricture was diagnosed and treated by endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous procedures in 100 patients (45%). The group of 21 patients (mean age 57.0+/-5.6 years) that were eventually treated with a biliary Wallstent was studied retrospectively.
  
  
  RESULTS
  Significant persistent proximal or anastomotic strictures were diagnosed in 4 and 17 patients, respectively. A Wallstent was inserted by ERCP or through a percutaneous route in 18 and 3 patients, respectively. The mean interval between diagnosis and Wallstent insertion was 179.7+/-292.8 (0-1113) days. The mean total number of procedures required per patient was 7.4+/-5.5. The mean stent primary patency duration was 10.8+/-7.8 (0.9-25.1) months with a 24-month primary patency rate of 26% at a mean follow-up time of 37.8+/-17.2 months. A hepatico-jejunostomy was performed in five patients (24%). Two patients (10%) underwent retransplantation for diffuse ischemic cholangitis or chronic rejection. The overall complication rate was 4%.
  
  
  CONCLUSIONS
  Treatment of post-transplant biliary stenosis using a Wallstent is a valuable option for delaying or avoiding surgery in up to 70% of patients. Proximal stenosis can be treated in the same manner in selected patients with major comorbidities.
authors.affiliation: Hepatobiliary and Pancreatic Surgery Unit, Centre Hospitalier de l'Université de Montréal (CHUM), St-Luc Hospital, Montréal, Quebec, Canada.
authors.forename: F
authors.initials: F
authors.lastname: Vandenbroucke
authors.forename: M
authors.initials: M
authors.lastname: Plasse
authors.forename: M
authors.initials: M
authors.lastname: Dagenais
authors.forename: R
authors.initials: R
authors.lastname: Lapointe
authors.forename: R
authors.initials: R
authors.lastname: Lêtourneau
authors.forename: A
authors.initials: A
authors.lastname: Roy