Korean J Radiol.  2011 Dec;12(6):708-713. 10.3348/kjr.2011.12.6.708.

Temporary Placement of Stent Grafts in Postsurgical Benign Biliary Strictures: a Single Center Experience

• Vellody R
• Willatt JM
• Arabi M
• Cwikiel WB

• KMID: 1101925
• DOI: http://doi.org/10.3348/kjr.2011.12.6.708

Abstract

OBJECTIVE
To evaluate the effect of temporary stent graft placement in the treatment of benign anastomotic biliary strictures.
MATERIALS AND METHODS
Nine patients, five women and four men, 22-64 years old (mean, 47.5 years), with chronic benign biliary anastomotic strictures, refractory to repeated balloon dilations, were treated by prolonged, temporary placement of stent-grafts. Four patients had strictures following a liver transplantation; three of them in bilio-enteric anastomoses and one in a choledocho-choledochostomy. Four of the other five patients had strictures at bilio-enteric anastomoses, which developed after complications following laparoscopic cholecystectomies and in one after a Whipple procedure for duodenal carcinoma. In eight patients, balloon-expandable stent-grafts were placed and one patient was treated by insertion of a self-expanding stent-graft.
RESULTS
In the transplant group, treatment of patients with bilio-enteric anastomoses was unsuccessful (mean stent duration, 30 days). The patient treated for stenosis in the choledocho-choledochostomy responded well to consecutive self-expanding stent-graft placement (total placement duration, 112 days). All patients with bilio-enteric anastomoses in the non-transplant group were treated successfully with stent-grafts (mean placement duration, 37 days).
CONCLUSION
Treatment of benign biliary strictures with temporary placement of stent-grafts has a positive effect, but is less successful in patients with strictures developed following a liver transplant.

Keyword

Biliary anastomotic stricture; Benign stricture; Liver transplant

MeSH Terms

Adult
Anastomosis, Surgical/adverse effects
Cholestasis/etiology/*surgery
Constriction, Pathologic
Device Removal
Female
Foreign-Body Migration
Humans
Liver Transplantation/adverse effects
Male
Middle Aged
*Postoperative Complications
*Stents
Young Adult

Figure

• 

  Fig. 1 Stent graft in postsurgical benign biliary stricture.A. 46-year-old male patient following liver transplant with tight stenosis (arrow) at choledocho-choledochostomy. B. Placement of 9 mm self-expanding stent (Viabahn) across the stricture (arrow). C. Two months after placement, stent graft is pushed into bowel and there is free flow of contrast from biliary tree to bowel (arrow).

• 

  Fig. 2 Stent graft in postsurgical benign biliary stricture.A. Tight stricture (arrow) at hepaticojejunostomy in 38-year-old patient with bile duct injury following cholecystectomy. B. Placement of 8 mm stent-graft (I-cast) across stricture (arrow). C. Stent is pushed into bowel after 10 weeks, revealing patent anastomosis with free flow of contrast on subsequent cholangiogram (arrow).

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