930 EFFICACY AND SAFETY OF FULLY COVERED SELF-EXPANDABLE METALLIC STENTS IN BILIARY COMPLICATIONS AFTER LIVER TRANSPLANTATION: A LARGE COHORT OF TREATED PATIENTS

Abstract

Introduction and Objectives: After liver transplantation, the most common biliary complication is the anastomotic stricture, which is followed by biliary leakage. Studies have focused on the endoscopic treatment of biliary complications in transplanted patients with duct-to-duct reconstruction, showing a success rate of 70% to 80% after orthotopic liver transplantation and of 60% after livingrelated liver transplantation. Once the endoscopic approach fails, surgical treatment with a Roux-en-Y choledochojejunostomy is the sole alternative treatment. A preliminary study performed at our institute showed as the placement of fully covered metal stents is a valid alternative to surgery. Aims and Methods: The aim of this prospective observational study was to report the short and long/term efficacy andsafety of fully covered self-expandable metallic stents for the treatment of post-transplant biliary stenosis and leaks in alarge cohort of patients in whom conventional endoscopic retrograde cholangiopancreatography failed. Results: From January 2008 to October 2010, 46 patients (29 male) met the criteria of endoscopic treatment failure, and instead of surgery, a fully covered stent was placed. The mean age was 59.5±8.7 years (range 30–73). All patients had atleast 6 months of follow-up with a mean follow-up of 20 months (range 6–25). After removal, 31 patients showedresolution of both the biliary stenosis and leak while 15 patients did not achieve a significant clinical benefit. At thefollow-up only 2 patients showed biliary stenosis recurrence. No major complications occurred in any of the patients, except for stent migration in 14 patients, although these presented with no clinical consequences. Conclusion: In conclusion our experience confirms, in a large number of treated patients not responding to standard endoscopic treatment, that placement of fully covered metal stents is a valid and safe alternative to surgery.