Maintenance of the fistulous tract after recanalization via magnetic compression anastomosis in completely obstructed benign biliary stricture

Scand J Gastroenterol. Oct-Nov 2018;53(10-11):1393-1398. doi: 10.1080/00365521.2018.1526968. Epub 2018 Oct 23.

Abstract

Objective: This study compared the efficacy of a percutaneous transhepatic cholangioscopy (PTCS) catheter and a fully covered self-expandable metal stent (FCSEMS) for maintaining biliary tract patency after magnetic compression anastomosis (MCA).

Methods: This study included patients with completely obstructed benign biliary stricture (BBS), which was resolved by MCA and subsequent insertion of a PTCS catheter or FCSEMS. We compared the restenosis-free time after removal of the PTCS catheter or FCSEMS, and the rate of complications.

Results: A total of 49 patients were analyzed. The mean ages of the patients in these groups were 50.1 and 49.6 years, respectively. The predisposing conditions causing complete BBS were liver transplantation (n = 38), abdominal surgery (n = 10) and trauma (n = 1). The mean indwelling durations were 176 and 128 days in the PTCS catheter and FCSEMS groups, respectively. The mean follow-up duration after removal of the PTCS catheter and FCSEMS were 2259 and 680.5 days, respectively. Three patients in the PTCS group and three patients in the FCSEMS group experienced stricture relapse. The mean duration between recurrence and stent removal were 924 and 265 days, respectively, and the numbers of stricture-free days did not differ significantly between the two groups. The adverse event rate did not differ significantly between the PTCS and FCSEMS groups (50% vs. 24.2%, respectively).

Conclusions: FCSEMSs have an efficacy and safety similar to those of PTCS catheters for maintaining biliary tract patency after MCA, but are more convenient for patients.

Keywords: Cholestasis; extrahepatic; indwelling catheter; liver transplantation; self-expandable metallic stents.

MeSH terms

  • Adult
  • Anastomosis, Surgical*
  • Biliary Fistula / therapy*
  • Biliary Tract Surgical Procedures
  • Cholestasis / therapy*
  • Constriction, Pathologic / etiology
  • Constriction, Pathologic / therapy
  • Device Removal
  • Endoscopy, Digestive System
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Liver Transplantation
  • Magnets*
  • Male
  • Middle Aged
  • Postoperative Complications / therapy*
  • Proportional Hazards Models
  • Recurrence
  • Republic of Korea
  • Retrospective Studies
  • Self Expandable Metallic Stents / adverse effects