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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, and Dong Ki Lee 
 Therapeutic Advances in Gastroenterology, Vol.10(3) : 297-309, 2017 
Journal Title
 Therapeutic Advances in Gastroenterology 
Issue Date
anastomosis ; complication ; liver transplantation ; stent ; stricture
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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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Park, Hyeun Sung(박현성)
Sung, Se Yong(성세용)
Lee, Kwang Hun(이광훈)
Lee, Dong Ki(이동기) ORCID logo https://orcid.org/0000-0002-0048-9112
Jang, Sung Ill(장성일) ORCID logo https://orcid.org/0000-0003-4937-6167
Joo, Seung Moon(주승문) ORCID logo https://orcid.org/0000-0002-0647-2880
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