CC BY-NC-ND 4.0 · The Arab Journal of Interventional Radiology 2019; 3(01): 19-22
DOI: 10.4103/AJIR.AJIR_43_18
Original Article

Percutaneous Transhepatic Biodegradable Stent Placement for Benign Anastomotic Biliary Strictures: Short-Term Outcomes of a Single-Institution Experience

Mohammad Arabi
Division of Vascular Interventional Radiology, Department of Medical Imaging, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
,
Bassam Alrehaili
Division of Vascular Interventional Radiology, Department of Medical Imaging, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
,
Refaat Salman
Division of Vascular Interventional Radiology, Department of Medical Imaging, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
,
Shahbaz Qazi
Division of Vascular Interventional Radiology, Department of Medical Imaging, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
,
Omar Bashir
Division of Vascular Interventional Radiology, Department of Medical Imaging, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
,
Khalid Abdullah
King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
Department of Hepatobiliary and Transplant Surgery, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
,
Mohammad Almoaiqel
Division of Vascular Interventional Radiology, Department of Medical Imaging, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
› Institutsangaben
Financial support and sponsorship Nil.

Purpose: The purpose of this study was to assess the safety and effectiveness of biodegradable stents in the management of benign anastomotic biliary strictures. Materials and Methods: This retrospective study included all consecutive adult patients who underwent percutaneous biodegradable stent insertion for benign anastomotic biliary strictures that were refractory to cholangioplasty or biliary drainage-dependent or preferred stent placement to avoid long-term tube dependence. Fourteen stents were used in 12 patients (9 males) with a mean age of 53 years (range: 23–72 years). Ten patients had liver transplant (7 – choledochocholedochal anastomosis and 3 – hepaticojejunal anastomosis). Two patients had primary sclerosing cholangitis with hepaticojejunal anastomosis. The mean time since surgery was 5.5 years (6 months–16 years). Ten patients had an average of three (range: 1–6) previous sessions of biliary dilatation. Two patients initially preferred stent placement to avoid long-term tube dependence. Results: Technical and clinical success was achieved in all cases. One patient died 2 months after stent insertion because of progressive liver cirrhosis. No re-intervention was required in 8 (72%) of the remaining 11 patients at a mean follow-up time of 234 days (96–539 days). Three liver transplant patients required re-intervention at a mean time of 287 days. There were one severe procedure-related complication (cholangitis and sepsis) and one mild complication (transient septicemia). Stent migration into the bowel occurred in one case a few days after insertion, but this required no re-intervention. No procedure-related mortality occurred. Conclusion: Biodegradable biliary stent may offer a safe and effective option to avoid tube dependence in patients with benign anastomotic biliary strictures.



Publikationsverlauf

Artikel online veröffentlicht:
23. März 2021

© 2019. The Arab Journal of Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 
  • References

  • 1 Shanbhogue AK, Tirumani SH, Prasad SR, Fasih N, McInnes M. Benign biliary strictures: A current comprehensive clinical and imaging review. AJR Am J Roentgenol 2011;197:W295-306.
  • 2 Coté GA, Slivka A, Tarnasky P, Mullady DK, Elmunzer BJ, Elta G, et al. Effect of covered metallic stents compared with plastic stents on benign biliary stricture resolution: A randomized clinical trial. JAMA 2016;315:1250-7.
  • 3 Khan MA, Baron TH, Kamal F, Ali B, Nollan R, Ismail MK, 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;49:682-94.
  • 4 Martins FP, De Paulo GA, Contini MLC, Ferrari AP. Metal versus plastic stents for anastomotic biliary strictures after liver transplantation: A randomized controlled trial. Gastrointest Endosc 2018;87:131.e1-13.
  • 5 Giménez ME, Palermo M, Houghton E, Acquafresca P, Finger C, Verde JM, et al. Biodegradable biliary stents: A new approach for the management of hepaticojejunostomy strictures following bile duct injury. prospective study. Arq Bras Cir Dig 2016;29:112-6.
  • 6 Mauri G, Michelozzi C, Melchiorre F, Poretti D, Pedicini V, Salvetti M, et al. Benign biliary strictures refractory to standard bilioplasty treated using polydoxanone biodegradable biliary stents: Retrospective multicentric data analysis on 107 patients. Eur Radiol 2016;26:4057-63.
  • 7 Siiki A, Jesenofsky R, Löhr M, Nordback I, Kellomäki M, Gröhn H, et al. Biodegradable biliary stents have a different effect than covered metal stents on the expression of proteins associated with tissue healing in benign biliary strictures. Scand J Gastroenterol 2016;51:880-5.
  • 8 Siiki A, Rinta-Kiikka I, Sand J, Laukkarinen J. Endoscopic biodegradable biliary stents in the treatment of benign biliary strictures:First report of clinical use in patients. Dig Endosc 2017;29:118-21.
  • 9 Siiki A, Sand J, Laukkarinen J. A systematic review of biodegradable biliary stents: Promising biocompatibility without stent removal. Eur J Gastroenterol Hepatol 2018;30:813-8.
  • 10 Khalilzadeh O, Baerlocher MO, Shyn PB, Connolly BL, Devane AM, Morris CS, et al. Proposal of a new adverse event classification by the society of interventional radiology standards of practice committee. J Vasc Interv Radiol 2017;28:1432-7.e3.
  • 11 Martins FP, Kahaleh M, Ferrari AP. Management of liver transplantation biliary stricture: Results from a tertiary hospital. World J Gastrointest Endosc 2015;7:747-57.
  • 12 Tal AO, Finkelmeier F, Filmann N, Kylänpää L, Udd M, Parzanese I, et al. Multiple plastic stents versus covered metal stent for treatment of anastomotic biliary strictures after liver transplantation: A prospective, randomized, multicenter trial. Gastrointest Endosc 2017;86:1038-45.
  • 13 Grolich T, Crha M, Novotný L, Kala Z, Hep A, Nečas A, et al. Self-expandable biodegradable biliary stents in porcine model. J Surg Res 2015;193:606-12.
  • 14 Janousek L, Maly S, Oliverius M, Kocik M, Kucera M, Fronek J, et al. Bile duct anastomosis supplied with biodegradable stent in liver transplantation: The initial experience. Transplant Proc 2016;48:3312-6.
  • 15 Dopazo C, Diez I, Quintero J, Curell A, González-Junyent C, Caralt M, et al. Role of biodegradable stents as part of treatment of biliary strictures after pediatric and adult liver transplantation: An observational single-center study. J Vasc Interv Radiol 2018;29:899-904.