Biliary leak in post-liver-transplant patients

Is there any place for metal stent?

Fernanda P. Martins, Melissa Lapinska, Monica R. Gaidhane, Timothy Schmitt, Michel Kahaleh

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Article number684172
JournalHPB Surgery
Volume2012
DOIs
StatePublished - May 21 2012

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Stents
Metals
Transplants
Liver
Bile
Pathologic Constriction
Cholangitis
Self Expandable Metallic Stents
Drainage
Safety
Population

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Surgery

Cite this

Biliary leak in post-liver-transplant patients : Is there any place for metal stent? / Martins, Fernanda P.; Lapinska, Melissa; Gaidhane, Monica R.; Schmitt, Timothy; Kahaleh, Michel.

In: HPB Surgery, Vol. 2012, 684172, 21.05.2012.

Research output: Contribution to journalArticle

Martins, Fernanda P. ; Lapinska, Melissa ; Gaidhane, Monica R. ; Schmitt, Timothy ; Kahaleh, Michel. / Biliary leak in post-liver-transplant patients : Is there any place for metal stent?. In: HPB Surgery. 2012 ; Vol. 2012.
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abstract = "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.",
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