%0 Journal Article
%T Biliary Leak in Post-Liver-Transplant Patients: Is There Any Place for Metal Stent?
%A Fernanda P. Martins
%A Melissa Phillips
%A Monica R. Gaidhane
%A Timothy Schmitt
%A Michel Kahaleh
%J HPB Surgery
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/684172
%X 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. 1. Introduction Biliary complications are frequent after orthotopic liver transplantation (OLT), affecting 5 to 15% of patients after deceased OLT and 28 to 32% after right-lobe living donor OLT [1¨C4]. Post-OLT bile leaks are reported in 10 to 15% of patients and are usually an early complication and represent a high morbidity condition for the patient [5]. Endoscopic treatment is well recognized as first-line therapy in the management of post-OLT biliary leaks or stricture [1, 4, 6, 7]. Endoscopic retrograde cholangiography (ERC) with biliary sphincterotomy and/or transpapillary plastic stent placement is typically offered as standard treatment [8¨C10]. Successful endoscopic therapy for postsurgical bile leaks has been reported in 88 to 97% of cases and up to 83.9% in those secondary to OLT [11]. Covered self-expandable metallic stents (CSEMSs) have been increasingly used to treat benign biliary conditions and have been shown promising results for both biliary strictures and leakages [7, 12¨C14]. Their larger diameter, long-term patency, and proven removability have turned them into an appealing option to assess refractory and/or complex bile leaks [7, 13¨C15]. Although few studies have already
%U http://www.hindawi.com/journals/hpb/2012/684172/