title: Endoscopic Management of Post-Liver Transplantation Biliary Strictures With the Use of Fully Covered Metallic Stents.
abstract: OBJECTIVE
  The aim of this work was to evaluate the safety and efficacy of a fully covered self-expandable metal stent (FCSEMS) in the treatment of post-liver transplantation biliary strictures.
  
  
  METHODS
  From October 2009 to October 2014, 44 patients with post-liver transplantation biliary stenosis were treated with the use of endoscopic retrograde cholangiography and placement of FCSEMS after informed consent. The FCSEMS was scheduled to remain in situ for 3-6 months. Patients were followed at regular intervals to evaluate for symptoms and liver function tests. Technical success, complications, and patient outcome were analyzed.
  
  
  RESULTS
  All of the strictures were anastomotic, 52% having occurred within the 1st year following the transplantation. Placement of the FCSEMS was possible on the 1st attempt in 54% of patients. Stricture resolution at the time of stent removal was seen in 100% of the cases. During an average follow-up of 27.83 ± 18.3 months after stent removal, stenosis recurred in 9 out of 41 patients (21.9%). The average time of recurrence was 11.78 ± 13.3 months. In all of these cases, the recurrence was resolved by means of placement of another FCSEMS. In 4 cases, the recurrence was associated with a migration of the prosthesis, partial in 2 cases and total in 2 cases. Stent migration occurred in a total of 17 of the 41 patients (41.4%), in 13 of the 32 (40.6%) who had no recurrence of stenosis and in 4 of the 9 (44.4%) of those who experienced recurrence. The average numbers of endoscopic retrograde cholangiography studies required per patient were 2.8 in those with no recurrence and 3.3 in those with recurrence. No death was associated with the process.
  
  
  CONCLUSIONS
  FCSEMS is a safe effective alternative to plastic stents in the treatment of post-transplantation biliary strictures, resulting in a lower risk of complications and better patient acceptance.
authors.affiliation: Unidad de Hepatología-Trasplante Hepático, Hospital Regional Universitario de Málaga, Málaga, Spain; Unidad de Gestión Clínica de Aparato Digestivo, Hospital Regional Universitario de Málaga, Málaga, Spain. Electronic address: mjimenezp@commalaga.com.
authors.forename: M
authors.initials: M
authors.lastname: Jiménez-Pérez
authors.affiliation: Unidad de Gestión Clínica de Aparato Digestivo, Hospital Regional Universitario de Málaga, Málaga, Spain; Unidad de Endoscopia, Hospital Regional Universitario de Málaga, Málaga, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Melgar Simón
authors.affiliation: Unidad de Gestión Clínica de Aparato Digestivo, Hospital Regional Universitario de Málaga, Málaga, Spain; Unidad de Endoscopia, Hospital Regional Universitario de Málaga, Málaga, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Durán Campos
authors.affiliation: Unidad de Hepatología-Trasplante Hepático, Hospital Regional Universitario de Málaga, Málaga, Spain; Unidad de Gestión Clínica de Aparato Digestivo, Hospital Regional Universitario de Málaga, Málaga, Spain.
authors.forename: R
authors.initials: R
authors.lastname: González Grande
authors.affiliation: Unidad de Hepatología-Trasplante Hepático, Hospital Regional Universitario de Málaga, Málaga, Spain; Unidad de Gestión Clínica de Aparato Digestivo, Hospital Regional Universitario de Málaga, Málaga, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Rodrigo López
authors.affiliation: Unidad de Gestión Clínica de Aparato Digestivo, Hospital Regional Universitario de Málaga, Málaga, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Manteca González
mesh_terms: D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000473:pathology / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D002779:Cholestasis / Q000209:etiology; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D005260:Female; D005548:Foreign-Body Migration / Q000453:epidemiology; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome