Fully covered self-expandable mental stent in treatment of biliary stricture after liver transplantation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Qiyu ¹ ,  LI Xun ² , ZHANG Lei ² , MENG Wenbo ³ , ZHU Kexiang ¹

1. The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, P. R. China;
2. The Five Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, P. R. China;
3. The Very Important Person Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, P. R. China;

Corresponding author：

LI Xun, Email: lxdr21@126.com

Keywords：

orthotopic liver transplantation; endoscopic retrograde cholangiagraphy; biliary stricture; fully covered self-expandable mental stent

DOI：

10.7507/1007-9424.201808039

Video：

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Objective To evaluate safety and long-term efficacy of fully covered self-expandable mental stent (FCSEMS) in treatment of biliary stricture after liver transplantation (LT). Methods From January 2010 to June 2018, the data of patients with the biliary stricture after the LT underwent the endoscopic retrograde cholangiagraphy (ERCP) at the First Hospital of Lanzhou University were collected retrospectively. The therapeutic effect of the FCSEMS was evaluated. Results A total of 21 patients with the biliary stricture after the LT were treated. The success rate of the stent placement was 100%. The FCSEMSs were used in 7 cases and the only multiple plastic stents (MPSs) were used in 14 cases. There were no significant differences in the gender, age, time of biliary stricture, frequency of ERCP, recurrence time of biliary stricture, cure time of biliary stricture, curative effect, recurrence of biliary stricture, and incidence of complications between the patients treated with the FCSEMS and the MPS (P>0.050), but the number of plastic stents in the patients treated with the FCSEMS was significantly less than that in the patients treated only with the plastic stents (P<0.050), while the duration of stent retention was longer than that in the patients treated only with the plastic stents (P<0.050). Six patients were cured, 1 was remitted, and 2 were relapsed by the FCSEMS. Eight were cured, 3 were remitted, 3 were ineffective, and 5 were relapsed by the MPS alone. Conclusions FCSEMS might be an safe effective alternative to plastic stent in treatment of biliary stricture after LT, resulting in a longer duration placement, less number of plastic stent use. It is necessary to further accumulate cases to validate cure rate and recurrence rate of biliary stricture.

Citation： ZHANG Qiyu, LI Xun, ZHANG Lei, MENG Wenbo, ZHU Kexiang. Fully covered self-expandable mental stent in treatment of biliary stricture after liver transplantation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(9): 1044-1048. doi: 10.7507/1007-9424.201808039 Copy

1.	王华翔, 柯瑞盛, 黄兴华, 等. 心脏死亡供肝受体肝移植术后胆道并发症发生机制及预防的研究进展. 实用器官移植电子杂志, 2017, 5(4): 293-297.
2.	Kochhar G, Parungao JM, Hanouneh IA, et al. Biliary complications following liver transplantation. World J Gastroenterol, 2013, 19(19): 2841-2846.
3.	Mehta N, Heimbach J, Lee D, et al. Wait time of less than 6 and greater than 18 months predicts hepatocellular carcinoma recurrence after liver transplantation: proposing a wait time " Sweet Spot”. Transplantation, 2017, 101(9): 2071-2078.
4.	Kaffes A, Griffin S, Vaughan R, et al. A randomized trial of a fully covered self-expandable metallic stent versus plastic stents in anastomotic biliary strictures after liver transplantation. Therap Adv Gastroenterol, 2014, 7(2): 64-71.
5.	Tarantino I, Traina M, Mocciaro F, et al. Fully covered metallic stents in biliary stenosis after orthotopic liver transplantation. Endoscopy, 2012, 44(3): 246-250.
6.	Kao D, Zepeda-Gomez S, Tandon P, et al. Managing the post-liver trans plantation anastomotic biliary stricture: multiple plastic versus metal stents: a systematic review. Gastrointest Endosc, 2013, 77(5): 679-691.
7.	Pasha SF, Harrison ME, Das A, et al. Endoscopic treatment of anastomotic biliary strictures alter deceased donor liver transplantation: outcomes alter maximal stent therapy. Gastrointest Endosc, 2007, 66(1): 44-45.
8.	Chaput U, Scatton O, Bichard P, et al. Temporary placement of partially covered self-expandable metal stents for anastomotic biliary strictures after liver transplantation: a prospective, multicenter study. Gastrointest Endosc, 2010, 72(6): 1167-1174.
9.	Koksal AS, Eminler AT, Parlak E, et al. Management of biliary anastomotic strictures after liver transplantation. Transplant Rev (Orlando), 2017, 31(3): 207-217.
10.	Kahaleh M, Behm B, Clarke BW, et al. Temporary placement of covered self-expandable metal stents in benign biliary strictures: a new paradigm? (with video). Gastrointest Endosc, 2008, 67(3): 446-454.
11.	Jiménez-Pérez M, Melgar Simón JM, Durán Campos A, et al. Endoscopic management of post-liver transplantation biliary strictures with the use of fully covered metallic stents. Transplant Proc, 2016, 48(7): 2510-2514.
12.	Behm BW, Brock A, Clarke BW, et al. Cost analysis of temporarily placed covered self expandable metallic stents versus plastic stents in biliary strictures related to chronic pancreatitis. Gastrointest Endosc, 2007, 65: AB211.
13.	Traina M, Tarantino I, Barresi L, et al. Efficacy and safety of fully covered self-expandable metallic stents in biliary complications after liver transplantation: a preliminary study. Liver Transpl, 2009, 15(11): 1493-1498.
14.	García-Pajares F, Sánchez-Antolín G, Pelayo SL, et al. Covered metal stents for the treatment of biliary complications after orthotopic liver transplantation. Transplant Proc, 2010, 42(8): 2966-2969.
15.	Park JS, Lee SS, Song TJ, et al. Long-term outcomes of covered self-expandable metal stents for treating benign biliary strictures. Endoscopy, 2016, 48(5): 440-447.
16.	Coté GA, Slivka A, Tarnasky P, et al. Effect of covered metallic stents compared with plastic stents on benign biliary stricture resolution: a randomized clinical trial. JAMA, 2016, 315(12): 1250-1257.
17.	Martins FP, De Paulo GA, Contini MLC, et al. Metal versus plastic stents for anastomotic biliary strictures after liver transplantation: a randomized controlled trial. Gastrointest Endosc, 2018, 87(1): 131.
18.	Vandenbroucke F, Plasse M, Dagenais M, et al. Treatment of post liver transplantation bile duct stricture with self-expandable metallic stent. HPB (Oxford), 2006, 8(3): 202-205.
19.	Haapamäki C, Udd M, Halttunen J, et al. Endoscopic treatment of anastomotic biliary complications after liver transplantation using removable, covered, self-expandable metallic stents. Scand J Gastroenterol, 2012, 47(1): 116-121.

1. 王华翔, 柯瑞盛, 黄兴华, 等. 心脏死亡供肝受体肝移植术后胆道并发症发生机制及预防的研究进展. 实用器官移植电子杂志, 2017, 5(4): 293-297.
2. Kochhar G, Parungao JM, Hanouneh IA, et al. Biliary complications following liver transplantation. World J Gastroenterol, 2013, 19(19): 2841-2846.
3. Mehta N, Heimbach J, Lee D, et al. Wait time of less than 6 and greater than 18 months predicts hepatocellular carcinoma recurrence after liver transplantation: proposing a wait time " Sweet Spot”. Transplantation, 2017, 101(9): 2071-2078.
4. Kaffes A, Griffin S, Vaughan R, et al. A randomized trial of a fully covered self-expandable metallic stent versus plastic stents in anastomotic biliary strictures after liver transplantation. Therap Adv Gastroenterol, 2014, 7(2): 64-71.
5. Tarantino I, Traina M, Mocciaro F, et al. Fully covered metallic stents in biliary stenosis after orthotopic liver transplantation. Endoscopy, 2012, 44(3): 246-250.
6. Kao D, Zepeda-Gomez S, Tandon P, et al. Managing the post-liver trans plantation anastomotic biliary stricture: multiple plastic versus metal stents: a systematic review. Gastrointest Endosc, 2013, 77(5): 679-691.
7. Pasha SF, Harrison ME, Das A, et al. Endoscopic treatment of anastomotic biliary strictures alter deceased donor liver transplantation: outcomes alter maximal stent therapy. Gastrointest Endosc, 2007, 66(1): 44-45.
8. Chaput U, Scatton O, Bichard P, et al. Temporary placement of partially covered self-expandable metal stents for anastomotic biliary strictures after liver transplantation: a prospective, multicenter study. Gastrointest Endosc, 2010, 72(6): 1167-1174.
9. Koksal AS, Eminler AT, Parlak E, et al. Management of biliary anastomotic strictures after liver transplantation. Transplant Rev (Orlando), 2017, 31(3): 207-217.
10. Kahaleh M, Behm B, Clarke BW, et al. Temporary placement of covered self-expandable metal stents in benign biliary strictures: a new paradigm? (with video). Gastrointest Endosc, 2008, 67(3): 446-454.
11. Jiménez-Pérez M, Melgar Simón JM, Durán Campos A, et al. Endoscopic management of post-liver transplantation biliary strictures with the use of fully covered metallic stents. Transplant Proc, 2016, 48(7): 2510-2514.
12. Behm BW, Brock A, Clarke BW, et al. Cost analysis of temporarily placed covered self expandable metallic stents versus plastic stents in biliary strictures related to chronic pancreatitis. Gastrointest Endosc, 2007, 65: AB211.
13. Traina M, Tarantino I, Barresi L, et al. Efficacy and safety of fully covered self-expandable metallic stents in biliary complications after liver transplantation: a preliminary study. Liver Transpl, 2009, 15(11): 1493-1498.
14. García-Pajares F, Sánchez-Antolín G, Pelayo SL, et al. Covered metal stents for the treatment of biliary complications after orthotopic liver transplantation. Transplant Proc, 2010, 42(8): 2966-2969.
15. Park JS, Lee SS, Song TJ, et al. Long-term outcomes of covered self-expandable metal stents for treating benign biliary strictures. Endoscopy, 2016, 48(5): 440-447.
16. Coté GA, Slivka A, Tarnasky P, et al. Effect of covered metallic stents compared with plastic stents on benign biliary stricture resolution: a randomized clinical trial. JAMA, 2016, 315(12): 1250-1257.
17. Martins FP, De Paulo GA, Contini MLC, et al. Metal versus plastic stents for anastomotic biliary strictures after liver transplantation: a randomized controlled trial. Gastrointest Endosc, 2018, 87(1): 131.
18. Vandenbroucke F, Plasse M, Dagenais M, et al. Treatment of post liver transplantation bile duct stricture with self-expandable metallic stent. HPB (Oxford), 2006, 8(3): 202-205.
19. Haapamäki C, Udd M, Halttunen J, et al. Endoscopic treatment of anastomotic biliary complications after liver transplantation using removable, covered, self-expandable metallic stents. Scand J Gastroenterol, 2012, 47(1): 116-121.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Fully covered self-expandable mental stent in treatment of biliary stricture after liver transplantation

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