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Temporary placement of partially covered self-expandable metal stents for anastomotic biliary strictures after liver transplantation: a prospective, multicenter study.

Abstract：

BACKGROUND:Management of anastomotic biliary strictures after liver transplantation deserves optimization. OBJECTIVE:To evaluate placement and removal of partially covered self-expandable metal stents (PCSEMSs) in this setting. DESIGN:Prospective, multicenter, uncontrolled study. SETTING:Three French academic hospitals with liver transplantation units and tertiary referral endoscopy centers. PATIENTS:Twenty-two patients (18 men, 4 women, aged 49.7 ± 12 years) with anastomotic biliary stricture. Seventeen (77.3%) presented stricture recurrence after plastic stenting. INTERVENTIONS:PCSEMSs were placed across the stricture for 2 months and then removed. Patients were followed by clinical examination and liver function tests 1, 3, 6, 9, and 12 months after PCSEMS removal. MAIN OUTCOME MEASUREMENT:The ability to remove PCSEMS. RESULTS:PCSEMS placement was successful in all patients, after sphincterotomy in 21 patients. Stent-related complications included minor pancreatitis (3 patients), transient pain (1 patient), and cholangitis (1 patient). Stent removal was achieved in all patients but 2 whose stents had migrated distally. Partial stent dislocation was noted in 5 patients (upward in 4, downward in 1). Complications associated with stent removal were minor, including self-contained hemorrhage (1 patient) and fever (1 patient). The stricture persisted at the end of treatment in 3 patients (13.6%), all of whom had stent migration or dislocation. Recurrence of anastomotic stricture after initial success occurred in 9 of 19 patients (47.4%) within 3.5 ± 2.1 months. Sustained stricture resolution was observed in 10 of 19 patients (52.6%), 45.6% from an intent-to-treat perspective. LIMITATIONS:Uncontrolled study with limited follow-up. CONCLUSIONS:Temporary placement and removal of PCSEMSs in anastomotic biliary strictures after liver transplantation is feasible, although sometimes demanding. Stent migration may impair final outcome.

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

Chaput U,Scatton O,Bichard P,Ponchon T,Chryssostalis A,Gaudric M,Mangialavori L,Duchmann JC,Massault PP,Conti F,Calmus Y,Chaussade S,Soubrane O,Prat F

doi

10.1016/j.gie.2010.08.016

subject

Has Abstract

pub_date

2010-12-01 00:00:00

pages

1167-74

issue

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(10)01992-9

journal_volume

pub_type

杂志文章,多中心研究

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Temporary placement of partially covered self-expandable metal stents for anastomotic biliary strictures after liver transplantation: a prospective, multicenter study.