A unique type of fully covered metal stent for the management of post liver transplant biliary anastomotic strictures
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RESEARCH ARTICLE
Open Access
A unique type of fully covered metal stent for the management of post liver transplant biliary anastomotic strictures Ben Warner* , Phillip Harrison, Muhammad Farman, John Devlin, David Reffitt, Yasser El-Sherif, Shirin E. Khorsandi, Andreas Prachalias, Miriam Cortes Cerisuelo, Krish Menon, Wayel Jassem, Parthi Srinivasan, Hector Vilca-Melendez, Michael Heneghan, Nigel Heaton and Deepak Joshi
Abstract Background: We report our experience of treating anastomotic strictures using a novel type of fully covered metal stent (FCSEMS). This stent, known as the Kaffes Stent, is short-length with an antimigration waist and is easily removable due to long retrieval wires deployed within the duodenum. Methods: Sixty-two patients underwent ERCP and Kaffes stent insertion for post-transplant anastomotic strictures following confirmation of a stricture on MRCP. These patients were retrospectively analysed for immediate and long-term stricture resolution, improvement in symptoms and liver function tests (LFTs), stricture recurrence and complication rates. Results: Of the 56 patients who had their stent removed at the time of analysis, 54 (96%) had immediate stricture resolution and 42 continued to have long-term resolution (mean follow-up period was 548 days). Of the 16 patients with symptoms of biliary obstruction, 13 had resolution of their symptoms. Overall, there was a significant improvement in LFTs after stent removal compared to before stent insertion. Complication rates were 15% with only one patient requiring biliary reconstruction. Conclusions: The Kaffes stent is effective and safe at resolving post liver transplant biliary anastomotic strictures. Keywords: ERCP, Anastomotic strictures, FCSEMS, Biliary
Background Anastomotic strictures are isolated, short-length strictures affecting 4–9% of patients post-liver transplantation, typically associated with technical factors such as bile leaks, the length of the donor bile duct, suture placement and size discrepancy [1, 2]. They typically develop 5–8 months after transplantation [3]. Stenting has historically been with plastic stents, on a 3-monthly basis for up to a year. Although multiple plastic stent (MPS) placement has higher efficacy at * Correspondence: [email protected] Institute of Liver Studies, King’s College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
resolving strictures compared to single plastic stents (SPS), plastic stents in general are at risk of stent occlusion, and often require multiple ERCPs before stricture resolution is achieved [4]. FCSEMS (fully covered self expanding metallic stents) have been shown to resolve benign strictures; however, stent migration can occur because the centre of the stent does not always overlie the stricture [5–7]. Kaffes stents (Taewoong Medical) are a novel type of FCSEMS that have a short-length, an antimigration waist, and long removal wires which lie within the duodenum for easy removal. The ends of the stents are larger in diameter than the mid-point. This uniqu
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