Document Detail


Temporary placement of partially covered self-expandable metal stents for anastomotic biliary strictures after liver transplantation: a prospective, multicenter study.
MedLine Citation:
PMID:  20970790     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
BACKGROUND: Management of anastomotic biliary strictures after liver transplantation deserves optimization.
OBJECTIVE: To evaluate placement and removal of partially covered self-expandable metal stents (PCSEMSs) in this setting.
DESIGN: Prospective, multicenter, uncontrolled study.
SETTING: Three French academic hospitals with liver transplantation units and tertiary referral endoscopy centers.
PATIENTS: Twenty-two patients (18 men, 4 women, aged 49.7 ± 12 years) with anastomotic biliary stricture. Seventeen (77.3%) presented stricture recurrence after plastic stenting.
INTERVENTIONS: PCSEMSs were placed across the stricture for 2 months and then removed. Patients were followed by clinical examination and liver function tests 1, 3, 6, 9, and 12 months after PCSEMS removal.
MAIN OUTCOME MEASUREMENT: The ability to remove PCSEMS.
RESULTS: PCSEMS placement was successful in all patients, after sphincterotomy in 21 patients. Stent-related complications included minor pancreatitis (3 patients), transient pain (1 patient), and cholangitis (1 patient). Stent removal was achieved in all patients but 2 whose stents had migrated distally. Partial stent dislocation was noted in 5 patients (upward in 4, downward in 1). Complications associated with stent removal were minor, including self-contained hemorrhage (1 patient) and fever (1 patient). The stricture persisted at the end of treatment in 3 patients (13.6%), all of whom had stent migration or dislocation. Recurrence of anastomotic stricture after initial success occurred in 9 of 19 patients (47.4%) within 3.5 ± 2.1 months. Sustained stricture resolution was observed in 10 of 19 patients (52.6%), 45.6% from an intent-to-treat perspective.
LIMITATIONS: Uncontrolled study with limited follow-up.
CONCLUSIONS: Temporary placement and removal of PCSEMSs in anastomotic biliary strictures after liver transplantation is feasible, although sometimes demanding. Stent migration may impair final outcome.
Authors:
Ulriikka Chaput; Olivier Scatton; Philippe Bichard; Thierry Ponchon; Ariane Chryssostalis; Marianne Gaudric; Luigi Mangialavori; Jean-Christophe Duchmann; Pierre-Philippe Massault; Filomena Conti; Yvon Calmus; Stanislas Chaussade; Olivier Soubrane; Frédéric Prat
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Gastrointestinal endoscopy     Volume:  72     ISSN:  1097-6779     ISO Abbreviation:  Gastrointest. Endosc.     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-29     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0010505     Medline TA:  Gastrointest Endosc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1167-74     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
Affiliation:
Hepato-gastroenterology Department, Hôpital Cochin, Paris-Descartes University, Paris, France.
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