Treatment of Biliary Stricture After Live Donor Liver Transplantation With Combined Metal and Plastic Stent Insertion: A Feasibility and Safety Study.

Background: Fully covered-self expandable metal stents (Fc-SEMSs) have a challenging use in the treatment of anastomosis strictures (ASs) after live donor liver transplantation (LDLT) because they can occlude secondary branch biliary ducts when placed above the biliary bifurcation. In this study we evaluated the technical feasibility and safety of combining Fc-SEMSs with plastic stent(s) inserted to the secondary branch biliary ducts for the treatment of ASs after LDLT. Methods: The study group included 22 patients (12 men, aged 51+/-11 years) with anastomotic biliary stricture after LDLT. A Fc-SEMS, 8-10 mm in diameter, was inserted to the straight, dilated main duct and plastic stent(s) were inserted to the secondary branches to avoid their occlusion. Stents were left in place for 2 months and removed with a stent retrieving forceps. Technical feasibility including technical success, successful removal and adverse events of this novel strategy were evaluated. Results: Fc-SEMSs were successfuly deployed and removed in all of the cases. Three patients (13.6%) had pain requiring intravenous analgesia and Fc-SEMS had to be removed because of unbearable pain in 1 of them. Three patients (13.6%) developed cholangitis due to occlusion of unrecognized secondary branch biliary ducts. Primary stricture resolution rate was achieved in 17 of 19 patients (89.5%). Recurrence was observed in 3 patients (17.6%) after a mean follow-up duration of 154.3+/-52.6 (range 104-304) days. Conclusion: Combination of Fc-SEMS and plastic stent(s) is technically feasible and safe for the treatment of anastomotic biliary strictures after LDLT. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2nLCrMv