Abstract
BackgroundEndoscopic balloon dilation and/or plastic stent placement has been a standard method for treating biliary strictures complicated post living donor liver transplantation (LDLT). The strictures may be refractory to endoscopic treatment and require long-term stent placement. However, consensus on the optimal period of the stent indwelling and usefulness of the inside stent does not exist.MethodsWe evaluated the long-term efficacy of stent treatment in patients with biliary stricture post LDLT. In addition, we compared the stent patency between inside stent and conventional outside stent.ResultsA total of 98 ERC sessions (median 6: range 1–14) performed on 16 patients receiving endoscopic treatment for biliary strictures post LDLT with duct-to-duct biliary reconstruction were analyzed. Biliary strictures successfully treated in 14 patients (88%) included 7 patients (44%) showing improvement of biliary strictures with repeated endoscopic stent placement. Stent replacement was carried out every 6 to 12 months for the remainder 7 patients (44%). Biliary stents were placed in 87 sessions (77 inside sessions and 10 outside sessions). Stent migration occurred 13 times (16%) and none of the inside stent sessions and the outside stent sessions, respectively. Median patency of inside stent and outside stent were 222 days (range; 8–1736) and 99 days (range; 7–356), respectively. The stent occlusion was significantly less in inside stent than in outside stent (p < 0.001). Stone formation was observed in 14 (18%) of the inside stent and 3 (30%) of the outside stent. Biliary stones were small and successfully removed endoscopically.ConclusionsThe endoscopic treatment using inside stent was useful in the management of biliary strictures after LDLT.
Highlights
Endoscopic balloon dilation and/or plastic stent placement has been a standard method for treating biliary strictures complicated post living donor liver transplantation (LDLT)
In this study, we analyzed a total of 98 endoscopic retrograde cholangiography (ERC) sessions for 16 patients undergoing endoscopic treatment of biliary stricture after LDLT with duct-to-duct biliary reconstruction
Biliary strictures were successfully treated in 14 patients (88%)
Summary
Endoscopic balloon dilation and/or plastic stent placement has been a standard method for treating biliary strictures complicated post living donor liver transplantation (LDLT). Koizumi et al BMC Gastroenterology (2020) 20:92 across the papilla and its distal end is exposed to the duodenum This may lead to free reflux of duodenal contents through the stent, which is believed to be the major cause of stent occlusion [10, 11]. Plastic stent usually requires prophylactic replacement every 2 to 4 months, especially in immunocompromised LDLT patients [12]. To avoid this complication and to aid prolongation of stent patency, usefulness of inside stent placed into proximal to the sphincter of Oddi has been reported [13, 14]. There are a few studies showing treatments for benign bile duct stricture, an optimal period of stent indwelling and usefulness of inside stent has not obtained a consensus. We compared the stent patency between inside stent placement and conventional outside stent placement
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