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Title: Success and complications of an intra-ductal fully covered self-expanding metal stent (ID-FCSEMS) to treat anastomotic biliary strictures (AS) after orthotopic liver transplantation (OLT)
Austin Authors: Aepli, Patrick;St. John, Andrew;Gupta, Saurabh;Hourigan, Luke F;Vaughan, Rhys;Efthymiou, Marios ;Kaffes, Arthur
Affiliation: Department of Gastroenterology and Hepatology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
Department of Gastroenterology and Hepatology, University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia
Gastroenterology and Hepatology
Department of Gastroenterologist and Therapeutic Endoscopist, Royal Prince Alfred Hospital, Newtown, NSW, Australia
University of Melbourne, Victoria, Australia
Issue Date: Apr-2017
Date: 2016-08-29
Publication information: Surgical Endoscopy 2017; 31(4): 1558-1563
Abstract: BACKGROUND: Anastomotic biliary strictures (AS) after orthotopic liver transplantation (OLT) belong to the most common biliary complications and cause the biggest morbidity burden after OLT. Metal stents for benign biliary strictures are gaining acceptance with many published series. Traditional metal stent designs seem to have poor durability in AS after OLT. Novel intra-ductal stents are showing promise in these strictures. As a result, we designed a special stent with an antimigration waist and a short stent length with a long removal string that rests in the duodenum for easy removal. PATIENTS AND METHODS: This is a retrospective multi-centre Australian study of AS after OLT treated with a novel intra-ductal fully covered self-expanding metal stent. From August 2008 to October 2014, records from three liver transplant centres were reviewed. RESULTS: Totally 36 ID-FCSEMS were inserted in 31 cases to treat an AS after OLT. The mean age of the patients was 56 years, and 61 % were male. The mean time of AS presentation after OLT was 20.3 months. Eight out of our 31 patients were previously treated using multiple plastic stenting over time without any success. Treatment with the ID-FCSEMS was performed with an average treatment time of 3.8 months. Stricture resolution was achieved in 100 %. All attempted stents removals were successful without any difficulty. Complications were reported in 6.5 %. It was pleasing that only one case of stent migration (2.8 %) was seen. Follow-up showed seven cases of AS recurrence (24.1 %), and all were treated successfully with repeat ERCP and stenting (some metal, some plastic). CONCLUSION: This novel ID-FCSEMS has a high clinical success and low complication rate, and in particular, there was only one case of stent migration. As a result, this stent type is preferred to traditional metal stents for treating AS after OLT.
DOI: 10.1007/s00464-016-5138-9
Journal: Surgical Endoscopy
PubMed URL:
Type: Journal Article
Subjects: Anastomotic biliary stricture
Benign biliary stricture
Intra-ductal fully covered self-expanding metal stent
Orthotopic liver transplantation
Appears in Collections:Journal articles

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