title: Definitive outcomes of self-expandable metal stents in patients with refractory post-transplant biliary anastomotic stenosis.
abstract: BACKGROUND
  Endoscopic retrograde cholangio-pancreatography is the gold standard of treatment in patients with biliary complications after liver transplantation. The benefits of fully covered self-expandable metal stents (FCSEMS) lie in their relative simplicity and the need for only two procedures, one for insertion, and the other for removal. Several case series have been published on such stents with generally good outcomes. Objective is to analyze definitive long-term outcomes of this treatment.
  
  
  METHODS
  Prospective, observational study in a single, tertiary-care referral centre. All consecutive patients with post-transplant biliary stenosis/leak were treated with FCSEMS after failure of conventional treatment. Recurrence was evaluated after four years.
  
  
  RESULTS
  From February 2008 to April 2012, 70 patients were included. In all patients, the metal stent was successfully placed. After a mean of 86.7 ± 38.4 days, the stent was removed. Forty-six patients (65.7%) showed resolution. After a mean of 4 ± 1.2 years, 61% of patients maintained the results, but 39% showed recurrence. On the tested variables the diagnosis of stenosis, the number of previous procedures and plastic stents placed correlate with better long-term results.
  
  
  CONCLUSIONS
  This series suggests a lack of long-term advantages of FCSEMS over plastic stents in the management of biliary stenosis after liver transplantation.
authors.affiliation: Endoscopy Service, Department of Diagnostic and Therapeutic Services, ISMETT/UPMC, Palermo, Italy. Electronic address: itarantinoi@ismett.edu.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Tarantino
authors.affiliation: Endoscopy Service, Department of Diagnostic and Therapeutic Services, ISMETT/UPMC, Palermo, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Barresi
authors.affiliation: Endoscopy Service, Department of Diagnostic and Therapeutic Services, ISMETT/UPMC, Palermo, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Curcio
authors.affiliation: Endoscopy Service, Department of Diagnostic and Therapeutic Services, ISMETT/UPMC, Palermo, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Granata
authors.affiliation: Endoscopy Service, Department of Diagnostic and Therapeutic Services, ISMETT/UPMC, Palermo, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Ligresti
authors.affiliation: Information Technology Department, ISMETT, Palermo, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Tuzzolino
authors.affiliation: Hepatology Department, IsMeTT, Palermo, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Volpes
authors.affiliation: Endoscopy Service, Department of Diagnostic and Therapeutic Services, ISMETT/UPMC, Palermo, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Amata
authors.affiliation: Endoscopy Service, Department of Diagnostic and Therapeutic Services, ISMETT/UPMC, Palermo, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Traina
mesh_terms: D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000628:therapy; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002779:Cholestasis / Q000209:etiology / Q000628:therapy*; D003251:Constriction, Pathologic / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*; D011446:Prospective Studies; D012008:Recurrence; D000069322:Self Expandable Metallic Stents; D016896:Treatment Outcome
keywords: Biliary leak; Biliary stenosis; Fully covered self-expandable metal stent; Liver transplantation