Fully covered metallic stents in biliary stenosis after orthotopic liver transplantation (original) (raw)
Endoscopy 2012; 44(03): 246-250
DOI: 10.1055/s-0031-1291465
© Georg Thieme Verlag KG Stuttgart · New York
M. Traina
Department of Gastroenterology, ISMETT/UPMC, Palermo, Italy
,
F. Mocciaro
Department of Gastroenterology, ISMETT/UPMC, Palermo, Italy
,
L. Barresi
Department of Gastroenterology, ISMETT/UPMC, Palermo, Italy
,
G. Curcio
Department of Gastroenterology, ISMETT/UPMC, Palermo, Italy
,
M. Di Pisa
Department of Gastroenterology, ISMETT/UPMC, Palermo, Italy
,
A. Granata
Department of Gastroenterology, ISMETT/UPMC, Palermo, Italy
,
R. Volpes
Department of Gastroenterology, ISMETT/UPMC, Palermo, Italy
,
B. Gridelli
Department of Gastroenterology, ISMETT/UPMC, Palermo, Italy
Further Information
Publication History
submitted 15 March 2011
accepted after revision 23 September 2011
Publication Date:
21 February 2012 (online)
Background and study aims: Data from a preliminary study suggested that the placement of a fully covered metal stent may be a valid alternative to surgery in patients who do not respond to standard endoscopic treatment. The aims of the current study were to evaluate the clinical success of self-expandable metallic stents (SEMS) in a large cohort of patients and with a long follow-up, and the effectiveness of SEMS placement as a first-line procedure.
Materials and methods: Between January 2008 and August 2010, 54 consecutive patients with biliary complications following orthotopic liver transplantation were treated with SEMS placement: 39 after failure of conventional endoscopic therapy (Group I), and 15 with no previous endoscopic treatment who were undergoing SEMS placement as first-line treatment for complications (Group II).
Results: In Group I, resolution after SEMS removal was observed in 71.8 % of patients. Mean follow-up after resolution was 22.1 ±10 months. Recurrence of the complication was observed in 14.3 % of patients after a mean of 8.5 months and SEMS migration was observed in 33.3 % of patients. In Group II, resolution was observed in 53.3 % of patients. Mean follow-up after resolution was 14.4 ±2.2 months. Recurrence was observed in 25 % of patients and SEMS migration was observed in 46.7 %.
Conclusions: For endotherapy of biliary complications after orthotopic liver transplantation, metallic stents should not be used as the primary modality. In patients in whom the standard approach fails, treatment with temporary SEMS placement can solve biliary complications in almost three-quarters of cases; however stent migration (33 %) remains a problem.
References
- 1 Thuluvath PJ. Biliary complication after liver transplantation: the role of endoscopy. Endoscopy 2005; 37: 857-863
- 2 Bentabak K. Adult-to-adult living related liver transplantation: preliminary results of the Hepatic Transplantation Group in Algiers. Transplant Proc 2005; 37: 2873-2874
- 3 Thulavath PJ, Atassi T, Lee J. An endoscopic approach to biliary complications following orthotopic liver transplantation. Liver Int 2003; 23: 156-162
- 4 Tarantino I, Barresi L, Petridis I et al. Endoscopic treatment of biliary complications after liver transplantation. World J Gastroenterol 2008; 14: 4185-4189
- 5 Traina M, Tarantino I, Barresi L et al. Efficacy and safety of fully covered self-expandable metallic stents in biliary complications after liver transplantation: a preliminary study. Liver Transpl 2009; 15: 1493-1498
- 6 Boraschi P, Braccini G, Gigoni R et al. Detection of biliary complications after orthotopic liver transplantation with MR cholangiography. Magn Reson Imaging 2001; 19: 1097-1105
- 7 Stratta RJ, Wood RP, Langnas AN et al. Diagnosis and treatment of biliary tract complication after orthotopic liver ransplantation. Surgery 1989; 106: 675-683
- 8 Greif F, Bronsther OL, Van Thiel DH et al. The incidence, timing, and management of biliary tract complication after orthotopic liver transplantation. Ann Surg 1994; 219: 40-45
- 9 Khuroo M, Ashagar H, Khuroo N. Biliary disease after liver transplantation: the experience of King Faisal Specialist Hospital and Research Center, Riyadh. J Gastroenterol Hepatol 2005; 20: 217-228
- 10 Morelli J, Mulcahy HE, Wilner IR et al. Long-term outcomes for patients with post–liver transplant anastomotic biliary strictures treated by endoscopic stent placement. Gastrointest Endosc 2003; 58: 374-379
- 11 Kahaleh M, Behm B, Clarke BW et al. Temporary placement of covered self-expandable metal stents in benign biliary strictures: a new paradigm?. Gastrointest Endosc 2008; 67: 446-454
- 12 Mahajan A, Ho H, Sauer B et al. Temporally placement of fully covered self-expandable metal stents in benign biliary strictures: midterm evaluation (with video). Gastrointest Endosc 2009; 70: 303-309
- 13 García-Pajares F, Sánchez-Antolín G, Pelayo SL et al. Covered metal stents for the treatment of biliary complications after orthotopic liver transplantation. Transplant Proc 2010; 42: 2966-2969
- 14 Chaput U, Scatton O, Bichard P et al. Temporary placement of partially covered self-expandable metal stents for anastomotic biliary strictures after liver transplantation: a prospective, multicenter study. Gastrointest Endosc 2010; 72: 1167-1174