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Success and complications of an intra-ductal fully covered self-expanding metal stent (ID-FCSEMS) to treat anastomotic biliary strictures (AS) after orthotopic liver transplantation (OLT)

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Abstract

Background

Anastomotic biliary strictures (AS) after orthotopic liver transplantation (OLT) belong to the most common biliary complications and cause the biggest morbidity burden after OLT. Metal stents for benign biliary strictures are gaining acceptance with many published series. Traditional metal stent designs seem to have poor durability in AS after OLT. Novel intra-ductal stents are showing promise in these strictures. As a result, we designed a special stent with an antimigration waist and a short stent length with a long removal string that rests in the duodenum for easy removal.

Patients and methods

This is a retrospective multi-centre Australian study of AS after OLT treated with a novel intra-ductal fully covered self-expanding metal stent. From August 2008 to October 2014, records from three liver transplant centres were reviewed.

Results

Totally 36 ID-FCSEMS were inserted in 31 cases to treat an AS after OLT. The mean age of the patients was 56 years, and 61 % were male. The mean time of AS presentation after OLT was 20.3 months. Eight out of our 31 patients were previously treated using multiple plastic stenting over time without any success. Treatment with the ID-FCSEMS was performed with an average treatment time of 3.8 months. Stricture resolution was achieved in 100 %. All attempted stents removals were successful without any difficulty. Complications were reported in 6.5 %. It was pleasing that only one case of stent migration (2.8 %) was seen. Follow-up showed seven cases of AS recurrence (24.1 %), and all were treated successfully with repeat ERCP and stenting (some metal, some plastic).

Conclusion

This novel ID-FCSEMS has a high clinical success and low complication rate, and in particular, there was only one case of stent migration. As a result, this stent type is preferred to traditional metal stents for treating AS after OLT.

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Abbreviations

AS:

Anastomotic biliary stricture

BBS:

Benign biliary stricture

CBD:

Common bile duct

ERCP:

Endoscopic retrograde cholangiopancreatography

FCSEMS:

Fully covered self-expanding metal stent

ID-FCSEMS:

Intra-ductal fully covered self-expanding metal stent

MPS:

Multiple plastic stenting/multiple plastic stents

OLT:

Orthotopic liver transplantation

RCT:

Randomized controlled trial

SEMS:

Self-expandable metal stent

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Royal Prince Alfred Hospital, Sydney, NSW, Australia

    Patrick Aepli & Arthur Kaffes

  2. Department of Gastroenterology and Hepatology, University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia

    Andrew St. John, Saurabh Gupta & Luke F. Hourigan

  3. Department of Gastroenterology, University of Melbourne, Austin Hospital, Melbourne, VIC, Australia

    Rhys Vaughan & Marios Efthymiou

  4. Department of Gastroenterologist and Therapeutic Endoscopist, Royal Prince Alfred Hospital, Suite G10, 100 Carillon Ave, Newtown, NSW, 2042, Australia

    Arthur Kaffes

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  1. Patrick Aepli
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Correspondence to Arthur Kaffes.

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Disclosures

Dr. Aepli reports personal fees from Cook Medical, personal fees from Treier Endoscopy, personal fees from Abbvie, personal fees from Gilead, outside the submitted work. Dr. Gupta reports personal fees from Cook Medical, outside the submitted work. Dr. St. John, Dr. Hourigan, Dr. Vaughan, Dr. Efthymiou and Dr. Kaffes have no conflicts of interest or financial ties to disclose.

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Aepli, P., St. John, A., Gupta, S. et al. Success and complications of an intra-ductal fully covered self-expanding metal stent (ID-FCSEMS) to treat anastomotic biliary strictures (AS) after orthotopic liver transplantation (OLT). Surg Endosc 31, 1558–1563 (2017). https://doi.org/10.1007/s00464-016-5138-9

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