Paolo Marra1,2, Francesco Saverio Carbone3,4, Ludovico Dulcetta3,4, Pietro Andrea Bonaffini3,4, Riccardo Muglia3, Lorenzo D'Antiga5, Sandro Sironi3,4. 1. Department of Radiology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy. pmarra@asst-pg23.it. 2. School of Medicine and Surgery, University of Milan-Bicocca, 20126, Milan, Italy. pmarra@asst-pg23.it. 3. Department of Radiology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy. 4. School of Medicine and Surgery, University of Milan-Bicocca, 20126, Milan, Italy. 5. Department of Paediatric Hepatology, Gastroenterology and Transplantation, Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy.
Abstract
PURPOSE: Cholestasis due to benign biliary strictures is the most common biliary complication after pediatric split liver transplantation (SLT), decreasing graft survival, but consensus about its management lacks. Percutaneous transhepatic cholangiography, bilioplasty and internal-external biliary drainage (IEBD) are standard treatments. The aim of this report is to present the preliminary experience with a new biodegradable biliary stent in the management of post-SLT biliary strictures. MATERIALS AND METHODS: Between September 2020 and April 2021, SLT patients with a single anastomotic benign biliary stricture underwent percutaneous transhepatic implantation of an innovative 10F helical-shaped biodegradable biliary stent, featuring a slow degradation profile, in addition to the standard treatment with bilioplasty and IEBD. The device is unique and the first to be CE-marked for the use in this indication. RESULTS: Six pediatric patients (4 males; median age 8.6 years, interquartile range 3.7 years) underwent percutaneous stent implantation, without complications nor clinical cholestasis during a median follow-up of 271 days (IQR 120.25). Stent dislodgement occurred in one case. CONCLUSION: Preliminary data suggest that implantation of a new biodegradable biliary stent may be considered in the management of post-SLT cholestasis in pediatric patients. Some technical tips are useful during implantation. This device may prolong biliary drainage, potentially relieving the discomfort of long-term IEBD.
PURPOSE: Cholestasis due to benign biliary strictures is the most common biliary complication after pediatric split liver transplantation (SLT), decreasing graft survival, but consensus about its management lacks. Percutaneous transhepatic cholangiography, bilioplasty and internal-external biliary drainage (IEBD) are standard treatments. The aim of this report is to present the preliminary experience with a new biodegradable biliary stent in the management of post-SLT biliary strictures. MATERIALS AND METHODS: Between September 2020 and April 2021, SLT patients with a single anastomotic benign biliary stricture underwent percutaneous transhepatic implantation of an innovative 10F helical-shaped biodegradable biliary stent, featuring a slow degradation profile, in addition to the standard treatment with bilioplasty and IEBD. The device is unique and the first to be CE-marked for the use in this indication. RESULTS: Six pediatric patients (4 males; median age 8.6 years, interquartile range 3.7 years) underwent percutaneous stent implantation, without complications nor clinical cholestasis during a median follow-up of 271 days (IQR 120.25). Stent dislodgement occurred in one case. CONCLUSION: Preliminary data suggest that implantation of a new biodegradable biliary stent may be considered in the management of post-SLT cholestasis in pediatric patients. Some technical tips are useful during implantation. This device may prolong biliary drainage, potentially relieving the discomfort of long-term IEBD.
Authors: Miguel A De Gregorio; Eva Criado; Jose A Guirola; Enrique Alvarez-Arranz; Mercedes Pérez-Lafuente; Marta Barrufet; Maria D Ferrer-Puchol; Sandra Lopez-Minguez; Jose Urbano; Carlos Lanciego; Alexander Aguinaga; Antonio Capel; Maria D Ponce-Dorrego; Abel Gregorio Journal: Eur Radiol Date: 2020-03-27 Impact factor: 5.315