Biodegradable stents in the treatment of biliary strictures after liver transplantation – first experience

Česká verzia

Authors: Alžběta Hujová ¹ ; Jana Jarošová ¹ ; Peter Mačinga ¹ ; Julius Špičák ¹ ; Jiří Froněk ² ; Theodor Adla ³ ; Pavel Taimr ¹ ; Tomáš Hucl ¹
Authors place of work: Klinika hepatogastroenterologie, Institut klinické a experimentální medicíny, Praha ¹; Klinika transplantační chirurgie, Institut klinické a experimentální medicíny, Praha ²; Oddělení radiologie, Institut klinické a experimentální medicíny, Praha ³
Published in the journal: Gastroent Hepatol 2024; 78(4): 286-290
Category: Klinická a experimentální gastroenterologie: přehledová práce
doi: https://doi.org/10.48095/ccgh2024286

Summary

Biliary anastomotic strictures are one of the most common biliary complications in patients after liver transplantation. Biliary complications are associated with higher mortality, morbidity, risk of graft failure and usually require repeated endoscopic interventions with regular stent replacement for treatment. Biodegradable stents are new types of stents made of bio degradable polymers, which may have the main advantage of reducing the number of endoscopic interventions and associated complications. The aim of our article was to describe the cases of two patients after liver transplantation with early biliary anastomotic strictures, which were resolved by endoscopic placement of bio degradable stents. In both cases, endoscopic stent placement was technically feasible and there were no periprocedural or postprocedural complications. The clinical course and fol low-up imaging at 8 months showed regression of the strictures in both patients.

Keywords:

liver transplantation – benign biliary stenoses – bio degradable stent

Zdroje

1. Fasullo M, Patel M, Khanna L et al. Post-transplant biliary complications: advances in pathophysiology, diagnosis, and treatment. BMJ Open Gastroenterol 2022; 9 (1): e000778. doi: 10.1136/bmjgast-2021-000778.

2. Daniel K, Said A. Early biliary complications after liver transplantation. Clin Liver Dis 2017; 10 (3): 637. doi: 10.1002/cld.654.

3. Magro B, Tacelli M, Mazzola A et al. Biliary complications after liver transplantation: cur rent perspectives and future strategies. Hepatobiliary Surg Nutr 2021; 10 (1): 76–92. doi: 10.21037/hbsn.2019.09.01.

4. Moy BT, Birk JW. A review on the management of biliary complications after orthotopic liver transplantation. J Clin Transl Hepatol 2019; 7 (1): 61–71. doi: 10.14218/JCTH.2018.00028.

5. Costamagna G, Pandolfi M, Mutignani M et al. Long-term results of endoscopic management of postoperative bile duct strictures with increasing numbers of stents. Gastrointest Endosc 2001; 54 (2): 162–168. doi: 10.1067/mge. 2001.116876.

6. Kao D, Zepeda-Gomez S, Tandon P et al. Managing the post-liver transplantation anastomotic biliary stricture: multiple plastic versus metal stents: a systematic review. Gastrointest Endosc 2013; 77 (5): 679–691. doi: 10.1016/j.gie.2013.01.015.

7. Giri S, Jearth V, Sundaram S. Covered self-expanding metal stents versus multiple plastic stents for benign biliary strictures: an updated meta-analysis of randomized controlled trials. Cureus 2022; 14 (4): e24588. doi: 10.7759/cureus. 24588.

8. Khan MA, Baron TH, Kamal F et al. Efficacy of self-expandable metal stents in management of benign biliary strictures and comparison with multiple plastic stents: a meta-analysis. Endoscopy 2017; 49 (7): 682–694. doi: 10.1055/s-0043-109865.

9. Lorenzo-Zúñiga V, Moreno-de-Vega V, Marín I et al. Biodegradable stents in gastrointestinal endoscopy. World J Gastroenterol 2014; 20 (9): 2212–2217. doi: 10.3748/wjg.v20.i9.2212.

10. Kemppainen E, Talja M, Riihelä M et al. A bio resorbable urethral stent. An experimental study. Urol Res 1993; 21 (3): 235–238. doi: 10.1007/BF00590042.

11. Ginsberg G, Cope C, Shah J et al. In vivo evaluation of a new bio absorbable self-expanding biliary stent. Gastrointest Endosc 2003; 58 (5): 777–784. doi: 10.1016/s0016-5107 (03) 02016-9.

12. Siiki A, Rinta-Kiikka I, Sand J et al. Biodegradable biliary stent in the endoscopic treatment of cystic duct leak after cholecystectomy: the first case report and review of literature. J Laparoendosc Adv Surg Tech A 2015; 25 (5): 419–422. doi: 10.1089/lap.2015.0068.

13. Mauri G, Michelozzi C, Melchiorre F et al. Benign biliary strictures refractory to standard bilioplasty treated using polydoxanone bio degradable biliary stents: retrospective multicentric data analysis on 107 patients. Eur Radiol 2016; 26 (11): 4057–4063. doi: 10.1007/s00330-016-4278-6.

14. Siiki A, Sand J, Laukkarinen J. A systematic review of bio degradable biliary stents: promising bio compatibility without stent removal. Eur J Gastroenterol Hepatol 2018; 30 (8): 813–818. doi: 10.1097/MEG.0000000000001167.

15. Cahen DL, van der Merwe SW, Laleman W et al. A bio degradable non-covered self-expandable stent to treat pancreatic duct strictures in chronic pancreatitis: a proof of principle. Gastrointest Endosc 2018; 87 (2): 486–491. doi: 10.1016/j.gie.2017.08.018.

16. Almeida GG, Donato P. Biodegradable versus multiple plastic stent implantation in benign biliary strictures: a systematic review and meta-analysis. Eur J Radiol 2020; 125: 108899. doi: 10.1016/j.ejrad.2020.108899.

17. Battistel M, Senzolo M, Ferrarese A et al. Biodegradable biliary stents for percutaneous treatment of post-liver transplantation refractory benign biliary anastomotic strictures. Cardiovasc Intervent Radiol 2020; 43 (5): 749–755. doi: 10.1007/s00270-020-02442-4.

18. Janousek L, Maly S, Oliverius M et al. Bile DuctAnastomosis Supplied With Biodegradable Stentin Liver Transplantation: The Initial Experience.Transplantation proceedings 2016; 48 (10): 3312––3316. doi: 10.1016/j.transproceed.2016.09.039.

ORCID autorů

A. Hujová 0000-0002-1282-095X,

J. Jarošová 0000-0003-0010-0637,

P. Mačinga 0000-0003-3699-6914,

J. Špičák 0000-0002-3823-2881,

J. Froněk 0000-0003-2379-3886,

T. Adla 0000-0002-0577-1440,

P. Taimr 0000-0002-6272-4608,

T. Hucl 0000-0002-5648-4011.

Doručeno/Submitted: 29. 7. 2024

Přijato/Accepted: 8. 8. 2024

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