Treatment of post liver transplantation bile duct stricture with self-expandable metallic stent

Abstract

Objective: The aim of this study is to report our experience using self-expandable covered metallic stents (Wallstent) to treat different types of biliary strictures after orthotopic liver transplantation (OLT). Patients and Methods: Between January 1999 and July 2004, 222 OLTs were performed with choledocho-choledochostomy (CC) bile duct reconstruction. An anastomotic biliary stricture was diagnosed and treated by endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous procedures in 100 patients (45%). The group of 21 patients (mean age 57.0±5.6 years) that were eventually treated with a biliary Wallstent was studied retrospectively. Results: Significant persistent proximal or anastomotic strictures were diagnosed in 4 and 17 patients, respectively. A Wallstent was inserted by ERCP or through a percutaneous route in 18 and 3 patients, respectively. The mean interval between diagnosis and Wallstent insertion was 179.7±292.8 (0 - 1113) days. The mean total number of procedures required per patient was 7.4±5.5. The mean stent primary patency duration was 10.8±7.8 (0.9 - 25.1) months with a 24-month primary patency rate of 26% at a mean follow-up time of 37.8±17.2 months. A hepatico-jejunostomy was performed in five patients (24%). Two patients (10%) underwent retransplantation for diffuse ischemic cholangitis or chronic rejection. The overall complication rate was 4%. Conclusion: Treatment of post-transplant biliary stenosis using a Wallstent is a valuable option for delaying or avoiding surgery in up to 70% of patients. Proximal stenosis can be treated in the same manner in selected patients with major comorbidities. © 2006 Taylor & Francis.