Salvage therapy using self-expandable metal stents for recalcitrant anastomotic strictures after living-donor liver transplantation

Sung Ill Jang, Se Yong Sung, Hyunsung Park, Kwang Hun Lee, Seung Moon Joo, DongKi Lee

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Recently, there has been an increase in clinical success rates using nonsurgical methods to resolve anastomotic biliary strictures (ABSs) that develop after liver transplantation (LT). However, some strictures are particularly refractory and cannot be completely resolved by an endoscopic or percutaneous procedure. Consequently, the aim of this study was to examine the feasibility and efficacy of using a newly designed fully covered self-expandable metal stent (FCSEMS) to resolve refractory ABS. Methods: A total of 35 patients with an ABS that developed after LT, but could not be resolved by an endoscopic or percutaneous procedure, were included in this study. FCSEMSs were positioned endoscopically and removed after 2-3 months. After stent removal, the patients were followed to assess complications, including re-stenosis. Results: The mean period from LT to stricture was 13.7 months, and the mean duration of the stricture was 31.8 months. The type and mean number of procedures previously attempted were endoscopic retrograde cholangiopancreatography (ERCP) (9.1 ± 5.1) in 19 patients and percutaneous transhepatic biliary drainage (9.2 ± 4.8) in 16 patients. All patients had successful FCSEMS insertions and removals; the mean stent indwelling time was 3.2 months. The mean follow-up period was 18.7 months (range: 6.4-37.8 months). Stricture recurrence was observed in 6 of 29 patients (recurrence rate: 20.7%). The anastomotic stricture resolved with the FCSEMS insertion in 29 of 35 patients (clinical success rate: 82.9%). Conclusions: The newly designed FCSEMS is a potentially feasible and effective treatment for anastomotic strictures that develop after LT but are not amenable to treatment by conventional procedures.

Original languageEnglish
Pages (from-to)297-309
Number of pages13
JournalTherapeutic Advances in Gastroenterology
Volume10
Issue number3
DOIs
Publication statusPublished - 2017 Mar 1

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Salvage Therapy
Living Donors
Liver Transplantation
Pathologic Constriction
Stents
Self Expandable Metallic Stents
Recurrence
Endoscopic Retrograde Cholangiopancreatography
Drainage

All Science Journal Classification (ASJC) codes

  • Gastroenterology

Cite this

Jang, Sung Ill ; Sung, Se Yong ; Park, Hyunsung ; Lee, Kwang Hun ; Joo, Seung Moon ; Lee, DongKi. / Salvage therapy using self-expandable metal stents for recalcitrant anastomotic strictures after living-donor liver transplantation. In: Therapeutic Advances in Gastroenterology. 2017 ; Vol. 10, No. 3. pp. 297-309.
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abstract = "Background: Recently, there has been an increase in clinical success rates using nonsurgical methods to resolve anastomotic biliary strictures (ABSs) that develop after liver transplantation (LT). However, some strictures are particularly refractory and cannot be completely resolved by an endoscopic or percutaneous procedure. Consequently, the aim of this study was to examine the feasibility and efficacy of using a newly designed fully covered self-expandable metal stent (FCSEMS) to resolve refractory ABS. Methods: A total of 35 patients with an ABS that developed after LT, but could not be resolved by an endoscopic or percutaneous procedure, were included in this study. FCSEMSs were positioned endoscopically and removed after 2-3 months. After stent removal, the patients were followed to assess complications, including re-stenosis. Results: The mean period from LT to stricture was 13.7 months, and the mean duration of the stricture was 31.8 months. The type and mean number of procedures previously attempted were endoscopic retrograde cholangiopancreatography (ERCP) (9.1 ± 5.1) in 19 patients and percutaneous transhepatic biliary drainage (9.2 ± 4.8) in 16 patients. All patients had successful FCSEMS insertions and removals; the mean stent indwelling time was 3.2 months. The mean follow-up period was 18.7 months (range: 6.4-37.8 months). Stricture recurrence was observed in 6 of 29 patients (recurrence rate: 20.7{\%}). The anastomotic stricture resolved with the FCSEMS insertion in 29 of 35 patients (clinical success rate: 82.9{\%}). Conclusions: The newly designed FCSEMS is a potentially feasible and effective treatment for anastomotic strictures that develop after LT but are not amenable to treatment by conventional procedures.",
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Salvage therapy using self-expandable metal stents for recalcitrant anastomotic strictures after living-donor liver transplantation. / Jang, Sung Ill; Sung, Se Yong; Park, Hyunsung; Lee, Kwang Hun; Joo, Seung Moon; Lee, DongKi.

In: Therapeutic Advances in Gastroenterology, Vol. 10, No. 3, 01.03.2017, p. 297-309.

Research output: Contribution to journalArticle

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T1 - Salvage therapy using self-expandable metal stents for recalcitrant anastomotic strictures after living-donor liver transplantation

AU - Jang, Sung Ill

AU - Sung, Se Yong

AU - Park, Hyunsung

AU - Lee, Kwang Hun

AU - Joo, Seung Moon

AU - Lee, DongKi

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N2 - Background: Recently, there has been an increase in clinical success rates using nonsurgical methods to resolve anastomotic biliary strictures (ABSs) that develop after liver transplantation (LT). However, some strictures are particularly refractory and cannot be completely resolved by an endoscopic or percutaneous procedure. Consequently, the aim of this study was to examine the feasibility and efficacy of using a newly designed fully covered self-expandable metal stent (FCSEMS) to resolve refractory ABS. Methods: A total of 35 patients with an ABS that developed after LT, but could not be resolved by an endoscopic or percutaneous procedure, were included in this study. FCSEMSs were positioned endoscopically and removed after 2-3 months. After stent removal, the patients were followed to assess complications, including re-stenosis. Results: The mean period from LT to stricture was 13.7 months, and the mean duration of the stricture was 31.8 months. The type and mean number of procedures previously attempted were endoscopic retrograde cholangiopancreatography (ERCP) (9.1 ± 5.1) in 19 patients and percutaneous transhepatic biliary drainage (9.2 ± 4.8) in 16 patients. All patients had successful FCSEMS insertions and removals; the mean stent indwelling time was 3.2 months. The mean follow-up period was 18.7 months (range: 6.4-37.8 months). Stricture recurrence was observed in 6 of 29 patients (recurrence rate: 20.7%). The anastomotic stricture resolved with the FCSEMS insertion in 29 of 35 patients (clinical success rate: 82.9%). Conclusions: The newly designed FCSEMS is a potentially feasible and effective treatment for anastomotic strictures that develop after LT but are not amenable to treatment by conventional procedures.

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