Temporary placement of partially covered self-expandable metal stents for anastomotic biliary strictures after liver transplantation: a prospective, multicenter study.
BACKGROUND
Management of anastomotic biliary strictures after liver transplantation deserves optimization.


OBJECTIVE
To evaluate placement and removal of partially covered self-expandable metal stents (PCSEMSs) in this setting.


METHODS
Prospective, multicenter, uncontrolled study.


METHODS
Three French academic hospitals with liver transplantation units and tertiary referral endoscopy centers.


METHODS
Twenty-two patients (18 men, 4 women, aged 49.7 ± 12 years) with anastomotic biliary stricture. Seventeen (77.3%) presented stricture recurrence after plastic stenting.


METHODS
PCSEMSs were placed across the stricture for 2 months and then removed. Patients were followed by clinical examination and liver function tests 1, 3, 6, 9, and 12 months after PCSEMS removal.


METHODS
The ability to remove PCSEMS.


RESULTS
PCSEMS placement was successful in all patients, after sphincterotomy in 21 patients. Stent-related complications included minor pancreatitis (3 patients), transient pain (1 patient), and cholangitis (1 patient). Stent removal was achieved in all patients but 2 whose stents had migrated distally. Partial stent dislocation was noted in 5 patients (upward in 4, downward in 1). Complications associated with stent removal were minor, including self-contained hemorrhage (1 patient) and fever (1 patient). The stricture persisted at the end of treatment in 3 patients (13.6%), all of whom had stent migration or dislocation. Recurrence of anastomotic stricture after initial success occurred in 9 of 19 patients (47.4%) within 3.5 ± 2.1 months. Sustained stricture resolution was observed in 10 of 19 patients (52.6%), 45.6% from an intent-to-treat perspective.


CONCLUSIONS
Uncontrolled study with limited follow-up.


CONCLUSIONS
Temporary placement and removal of PCSEMSs in anastomotic biliary strictures after liver transplantation is feasible, although sometimes demanding. Stent migration may impair final outcome.
Hepato-gastroenterology Department, Hôpital Cochin, Paris-Descartes University, Paris, France.
Ulriikka
U
Chaput
Olivier
O
Scatton
Philippe
P
Bichard
Thierry
T
Ponchon
Ariane
A
Chryssostalis
Marianne
M
Gaudric
Luigi
L
Mangialavori
Jean-Christophe
JC
Duchmann
Pierre-Philippe
PP
Massault
Filomena
F
Conti
Yvon
Y
Calmus
Stanislas
S
Chaussade
Olivier
O
Soubrane
Frédéric
F
Prat
D000328:Adult; D000714:Anastomosis, Surgical; D002404:Catheterization; D002760:Cholangiopancreatography, Endoscopic Retrograde; D001651:Cholestasis, Extrahepatic / Q000175:diagnosis / Q000628:therapy*; D020099:Coated Materials, Biocompatible; D020878:Device Removal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy*; D011446:Prospective Studies; D011474:Prosthesis Design; D016717:Sphincterotomy, Endoscopic; D015607:Stents
D020099:Coated Materials, Biocompatible