Pinheiro LW, Martins FP, De Paulo GA, Contini MLC, Ferrari AP, Della Libera E. Endoscopic therapy using a self-expandable metallic stent with an anti-migration system for postorthotopic liver transplantation anastomotic biliary stricture. World J Gastrointest Endosc 2022; 14(9): 547-554 [PMID: 36186946 DOI: 10.4253/wjge.v14.i9.547]
Corresponding Author of This Article
Ermelindo Della Libera, MD, PhD, Adjunct Associate Professor, Department of Endoscopy Unit, Hosp Israelita Albert Einstein, Rua Ruggero Fsano, s/n - Pavilhão Vick e Joseph Safra - Piso I3 - Morumbi - SP, São Paulo 04026001, Brazil. edellaliberajr@uol.com.br
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Sep 16, 2022; 14(9): 547-554 Published online Sep 16, 2022. doi: 10.4253/wjge.v14.i9.547
Endoscopic therapy using a self-expandable metallic stent with an anti-migration system for postorthotopic liver transplantation anastomotic biliary stricture
Larissa Wermelinger Pinheiro, Fernanda Prata Martins, Gustavo Andrade De Paulo, Mônica Lúcia Campos Contini, Angelo Paulo Ferrari, Ermelindo Della Libera
Larissa Wermelinger Pinheiro, Angelo Paulo Ferrari, Ermelindo Della Libera, Department of Gastroenterology, Federal University of São Paulo/Escola Paulista de Medicina, São Paulo 04023-900, Brazil
Fernanda Prata Martins, Gustavo Andrade De Paulo, Mônica Lúcia Campos Contini, Angelo Paulo Ferrari, Ermelindo Della Libera, Department of Endoscopy Unit, Hosp Israelita Albert Einstein, São Paulo 04042033, Brazil
Author contributions: Pinheiro LW, Martins FP, Contini MLC, and De Paulo GA contributed to the data acquisition; Pinheiro LW, De Paulo GA, Ferrari AP, and Della Libera E contributed to the data analysis and interpretation; Pinheiro LW contributed to the elaboration of article draft; Martins FP and Contini MLC contributed to the elaboration and review of article draft, critical review for important intellectual content; De Paulo GA contributed to the critical review of final paper for important intellectual content; Ferrari AP and Della Libera E contributed to the critical review and approval of the final submitted version.
Institutional review board statement: This retrospective study was approved by the Institution's Human Research Committee of Hospital Israelita Albert Einstein (No. 37755020.3.0000.0071).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) licence, which permits others to distribute, remix, adapt, and build upon this work noncommercially and licence their derivative works on different terms, provided the original work is properly cited and the use is noncommercial. See https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ermelindo Della Libera, MD, PhD, Adjunct Associate Professor, Department of Endoscopy Unit, Hosp Israelita Albert Einstein, Rua Ruggero Fsano, s/n - Pavilhão Vick e Joseph Safra - Piso I3 - Morumbi - SP, São Paulo 04026001, Brazil. edellaliberajr@uol.com.br
Received: February 3, 2022 Peer-review started: February 3, 2022 First decision: April 12, 2022 Revised: April 19, 2022 Accepted: August 6, 2022 Article in press: August 6, 2022 Published online: September 16, 2022
Abstract
BACKGROUND
Endoscopic therapy using multiple plastic stents (MPSs) is the standard therapy for postorthotopic liver transplantation (p-OLT) anastomotic biliary stricture (ABS). However, this approach demands repeated procedures. Recent studies using fully covered self-expandable metallic stents (FCSEMS) have shown encouraging results, but migration occurs in 10% to 40% of cases. The objective of this retrospective study was to evaluate the efficacy of endoscopic treatment using FCSEMS with an anti-migration system (Am-FCSEMS) in patients with p-OLT ABS.
AIM
To evaluate the efficacy of endoscopic treatment using an Am-FCSEMS in patients with p-OLT ABS.
METHODS
This study was conducted in a private tertiary care centre in São Paulo, Brazil and was approved by our institution's Human Research Committee. From April 2018 to October 2020, regardless of previous endoscopic treatment (MPS or FCSEMS), 17 patients with p-OLT ABS and indications for endoscopic therapy were included in this study. The exclusion criteria were pregnancy, nonanastomotic biliary or hilar stricture, hepatic artery stenosis/thrombosis, isolated biliary fistulae, a distance shorter than 2 cm from the stricture to the hepatic hilum, and patient refusal. The primary endpoint was the efficacy of p-OLT ABS endoscopic treatment using an Am-FCSEMS that remained in place for a 12-mo period. Biliary sphincterotomy was performed in patients with native papilla, and an Am-FCSEMS (10 mm in final diameter and 60 or 80 mm in length) was placed (HanarostentTM MI Tech, Co). Balloon stricture dilation was performed only if necessary to introduce the stent.
RESULTS
Three patients were excluded due to loss to follow-up before stent removal. Among the 14 patients included and followed, 7 were women, and the average age was 56 years (range: 28-76). The average period of Am-FCSEMS placement was 362 ± 109 d. Technical success occurred in all 14 patients (100%). There were no cases of distal stent migration. Complete resolution of the stricture occurred in 13/14 patients (92.85%). Adverse events occurred in 3/14 patients (21.42%): 2 patients with mild acute pancreatitis (14.28%) and 1 patient (7.14%) with stent dysfunction (occlusion by biliary sludge and stones, which was treated endoscopically without the need for stent removal). No deaths occurred related to therapy. All stents were removed using foreign body forceps or snares without difficulty. After Am-FCSEMS removal, all 13 patients who had ABS resolution were followed-up for an average of 411 ± 172 d, and there was no stricture recurrence or need for further endoscopic therapy.
CONCLUSION
In this retrospective study, endoscopy therapy using an Am-FCSEMS for p-OLT ABS was safe and effective, with a high stricture resolution rate that was probably due to the absence of stent migration.
Core Tip: This retrospective study evaluated the efficacy of endoscopic treatment using an anti-migration fully covered self-expandable metallic stents (Am-FCSEMS) in patients with postorthotopic liver transplantation (p-OLT) anastomotic biliary stricture (ABS). Technical success occurred in all patients (100%). Stricture resolution occurred in 13/14 patients (92.85%). Adverse events occurred in 3/14 patients (21.42%). There were no cases of distal stent migration. After Am-FCSEMS removal, all 13 patients who had ABS resolution were followed-up for an average of 411 d, and there was no stricture recurrence or need for further endoscopic therapy. Endoscopic therapy using an Am-FCSEMS for p-OLT ABS is safe and effective, with a high stricture resolution rate, probably due to the absence of stent migration.
