Biliary Leak in Post-Liver-Transplant Patients: Is There Any Place for Metal Stent?

Objectives. Endoscopic management of bile leak after orthotopic liver transplant (OLT) is widely accepted. Preliminary studies demonstrated encouraging results for covered self-expandable metal stents (CSEMS) in complex bile leaks. Methods. Thirty-one patients with post-OLT bile leaks underwent endoscopic temporary placement of CSEMS (3 partially CSEMS , 18 fully CSEMS with fins and 10 fully CSEMS with flare ends) between December 2003 and December 2010. Long-term clinical success and safety were evaluated. Results. Median stent indwelling and follow-up were 89 and 1,353 days for PCSEMS, 102 and 849 for FCSEMS with fins and 98 and 203 for FCSEMS with flare ends. Clinical success was achieved in 100%, 77.8%, and 70%, respectively. Postplacement complications: cholangitis (1) and proximal migration (1), both in the FCSEMS with fins. Postremoval complications were biliary strictures requiring drainage: PCSEMS (1), FCSEMS with fins (6) and with flare ends (1). There was no significant differences in the FCSEMS groups regarding clinical success, age, gender, leak location, previous treatment, stent indwelling, and complications. Conclusion. Temporary placement of CSEMS is effective to treat post-OLT biliary leaks. However, a high number of post removal biliary strictures occurred especially in the FCSEMS with fins. CSEMS cannot be recommended in this patient population.

[1]  T. Ponchon,et al.  Temporary placement of partially covered self-expandable metal stents for anastomotic biliary strictures after liver transplantation: a prospective, multicenter study. , 2010, Gastrointestinal endoscopy.

[2]  J. Álamo-Martínez,et al.  Use of fully covered self-expandable stent in biliary complications after liver transplantation: a case series. , 2010, Transplantation proceedings.

[3]  M. Pérez-Miranda,et al.  Covered metal stents for the treatment of biliary complications after orthotopic liver transplantation. , 2010, Transplantation proceedings.

[4]  J. Ostroff.  Management of biliary complications in the liver transplant patient. , 2010, Gastroenterology & hepatology.

[5]  M. Kahaleh,et al.  Management of Complications Associated with Partially Covered Biliary Metal Stents , 2010, Digestive Diseases and Sciences.

[6]  B. Gridelli,et al.  Efficacy and safety of fully covered self‐expandable metallic stents in biliary complications after liver transplantation: A preliminary study , 2009, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[7]  M. Kahaleh,et al.  Fully covered self-expandable metallic stents in the management of complex biliary leaks: preliminary data – a case series1 , 2009, Endoscopy.

[8]  E. Williams,et al.  Endoscopic management of biliary strictures after liver transplantation. , 2009, World journal of gastroenterology.

[9]  Minoru Tada,et al.  Measurement of radial and axial forces of biliary self-expandable metallic stents. , 2009, Gastrointestinal endoscopy.

[10]  J. Tabibian,et al.  Endoscopic treatment with multiple stents for post-liver-transplantation nonanastomotic biliary strictures. , 2009, Gastrointestinal endoscopy.

[11]  B. Gridelli,et al.  Endoscopic treatment of biliary complications after liver transplantation. , 2008, World journal of gastroenterology.

[12]  J. Tokar,et al.  Temporary placement of covered self-expandable metal stents in benign biliary strictures: a new paradigm? (with video). , 2008, Gastrointestinal endoscopy.

[13]  J. Tokar,et al.  Temporary placement of covered self-expandable metallic stents in patients with biliary leak: midterm evaluation of a pilot study. , 2007, Gastrointestinal endoscopy.

[14]  M. Makuuchi,et al.  Endoscopic Management of Biliary Complications after Adult Living Donor Liver Transplantation , 2006, The American Journal of Gastroenterology.

[15]  T. Baron,et al.  Insertion and removal of covered expandable metal stents for closure of complex biliary leaks. , 2006, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[16]  L. Grande,et al.  One thousand liver transplants: the hospital clinic experience. , 2005, Transplantation proceedings.

[17]  K. Byth,et al.  Impact of endoscopic intervention in 100 patients with suspected postcholecystectomy bile leak. , 2005, Gastrointestinal endoscopy.

[18]  J. Tokar,et al.  Removal of self-expandable metallic Wallstents. , 2004, Gastrointestinal endoscopy.

[19]  M. Bourke,et al.  Endoscopic therapy for bile leak based on a new classification: results in 207 patients. , 2004, Gastrointestinal endoscopy.

[20]  N. Chalasani,et al.  Biliary tract complications after orthotopic liver transplantation with choledochocholedochostomy anastomosis: endoscopic findings and results of therapy. , 2002, Gastrointestinal endoscopy.

[21]  G. Ginsberg,et al.  Endoscopic management of postoperative biliary complications in orthotopic liver transplantation. , 2000, Gastrointestinal endoscopy.

[22]  M. E. Ryan,et al.  Endoscopic intervention for biliary leaks after laparoscopic cholecystectomy: a multicenter review. , 1998, Gastrointestinal endoscopy.