Elevated stricture rate following the use of fully covered self-expandable metal biliary stents for biliary leaks following liver transplantation

Background: Biliary leaks and strictures are common complications after liver transplantation and can be managed surgically or endoscopically. Endoscopic management using fully covered self-expandable metal stents (FCSEMS) might provide some advantages over the commonly used plastic stents in the management of bile leaks after liver transplantation. Methods: Between December 2006 and January 2009, 17 liver transplant recipients underwent placement of a FCSEMS for treatment of biliary leaks. Results: FCSEMS were deployed at median of 18 days (range: 6-160) after liver transplantation and left in place for a median of 102 days (range: 35-427), with a median follow-up after FCSEMS removal of 407 days (range: 27-972). Long-term leak control was obtained in all but one patient. Complications included 6 clinically significant biliary strictures (35%), which were treated with repeat stent placement, and two clinically insignificant strictures (12%) which required no intervention. Additionally, three patients (18%) had biliary ulcerations after stent removal, confirmed by choledochoscopy, and were managed conservatively. Two patients required repeat liver transplantation due to hepatic artery thrombosis, and one patient died from sepsis unrelated to FCSEMS stenting. Conclusions: FCSEMS treat biliary leaks effectively, but carry a relatively high stricture risk in patients who have received liver transplants. FCSEMS cannot be recommended for management of biliary leaks following liver transplantation at this point.