Ilaria Tarantino1, Luca Barresi2, Gabriele Curcio2, Antonino Granata2, Dario Ligresti2, Fabio Tuzzolino3, Riccardo Volpes4, Michele Amata2, Mario Traina2. 1. Endoscopy Service, Department of Diagnostic and Therapeutic Services, ISMETT/UPMC, Palermo, Italy. Electronic address: itarantinoi@ismett.edu. 2. Endoscopy Service, Department of Diagnostic and Therapeutic Services, ISMETT/UPMC, Palermo, Italy. 3. Information Technology Department, ISMETT, Palermo, Italy. 4. Hepatology Department, IsMeTT, Palermo, Italy.
Abstract
BACKGROUND: Endoscopic retrograde cholangio-pancreatography is the gold standard of treatment in patients with biliary complications after liver transplantation. The benefits of fully covered self-expandable metal stents (FCSEMS) lie in their relative simplicity and the need for only two procedures, one for insertion, and the other for removal. Several case series have been published on such stents with generally good outcomes. Objective is to analyze definitive long-term outcomes of this treatment. METHODS: Prospective, observational study in a single, tertiary-care referral centre. All consecutive patients with post-transplant biliary stenosis/leak were treated with FCSEMS after failure of conventional treatment. Recurrence was evaluated after four years. RESULTS: From February 2008 to April 2012, 70 patients were included. In all patients, the metal stent was successfully placed. After a mean of 86.7 ± 38.4 days, the stent was removed. Forty-six patients (65.7%) showed resolution. After a mean of 4 ± 1.2 years, 61% of patients maintained the results, but 39% showed recurrence. On the tested variables the diagnosis of stenosis, the number of previous procedures and plastic stents placed correlate with better long-term results. CONCLUSIONS: This series suggests a lack of long-term advantages of FCSEMS over plastic stents in the management of biliary stenosis after liver transplantation.
BACKGROUND: Endoscopic retrograde cholangio-pancreatography is the gold standard of treatment in patients with biliary complications after liver transplantation. The benefits of fully covered self-expandable metal stents (FCSEMS) lie in their relative simplicity and the need for only two procedures, one for insertion, and the other for removal. Several case series have been published on such stents with generally good outcomes. Objective is to analyze definitive long-term outcomes of this treatment. METHODS: Prospective, observational study in a single, tertiary-care referral centre. All consecutive patients with post-transplant biliary stenosis/leak were treated with FCSEMS after failure of conventional treatment. Recurrence was evaluated after four years. RESULTS: From February 2008 to April 2012, 70 patients were included. In all patients, the metal stent was successfully placed. After a mean of 86.7 ± 38.4 days, the stent was removed. Forty-six patients (65.7%) showed resolution. After a mean of 4 ± 1.2 years, 61% of patients maintained the results, but 39% showed recurrence. On the tested variables the diagnosis of stenosis, the number of previous procedures and plastic stents placed correlate with better long-term results. CONCLUSIONS: This series suggests a lack of long-term advantages of FCSEMS over plastic stents in the management of biliary stenosis after liver transplantation.
Authors: Dayse Pereira da Silva Aparício; José Pinhata Otoch; Edna Frasson de Souza Montero; Muhammad Ali Khan; Everson Luiz de Almeida Artifon Journal: United European Gastroenterol J Date: 2016-11-22 Impact factor: 4.623