Department of Gastroenterology, ISMETT/UPMC, Via Tricomi 1, Palermo, Italy.
Endoscopy. 2012 Mar;44(3):246-50. doi: 10.1055/s-0031-1291465. Epub 2012 Feb 21.
Data from a preliminary study suggested that the placement of a fully covered metal stent may be a valid alternative to surgery in patients who do not respond to standard endoscopic treatment. The aims of the current study were to evaluate the clinical success of self-expandable metallic stents (SEMS) in a large cohort of patients and with a long followup,and the effectiveness of SEMS placement as a first-line procedure.
Between January 2008 and August 2010, 54 consecutive patients with biliary complications following orthotopic liver transplantation were treated with SEMS placement:39 after failure of conventional endoscopic therapy (Group I), and 15 with no previous endoscopic treatment who were undergoing SEMS placement as first-line treatment for complications(Group II).
In Group I, resolution after SEMS removal was observed in 71.8% of patients. Mean followup after resolution was 22.1 ±10 months. Recurrence of the complication was observed in 14.3%of patients after a mean of 8.5 months and SEMS migration was observed in 33.3% of patients. In Group II, resolution was observed in 53.3% of patients.Mean follow-up after resolution was 14.4±2.2 months. Recurrence was observed in 25% of patients and SEMS migration was observed in 46.7 %.
For endotherapy of biliary complications after orthotopic liver transplantation, metallic stents should not be used as the primary modality. In patients in whom the standard approach fails, treatment with temporary SEMS placement can solve biliary complications in almost three-quarters of cases; however stent migration(33 %) remains a problem.
初步研究数据表明，对于那些对标准内镜治疗无反应的患者，完全覆膜金属支架的放置可能是一种替代手术的有效方法。本研究的目的是评估大样本患者中自膨式金属支架（SEMS）的临床成功率和长期随访结果，并评估 SEMS 放置作为一线治疗的有效性。
2008 年 1 月至 2010 年 8 月，54 例原位肝移植术后胆道并发症患者接受了 SEMS 置入治疗：39 例为常规内镜治疗失败患者（I 组），15 例为无内镜治疗史患者，作为一线治疗并发症而行 SEMS 置入（II 组）。
I 组患者中，SEMS 取出后缓解率为 71.8%。缓解后平均随访时间为 22.1±10 个月。平均 8.5 个月后，14.3%的患者再次出现并发症，14.3%的患者出现 SEMS 迁移。II 组患者中，53.3%的患者缓解。缓解后平均随访时间为 14.4±2.2 个月。25%的患者复发，46.7%的患者 SEMS 迁移。
对于原位肝移植术后胆道并发症的内镜治疗，金属支架不应作为主要治疗方法。对于标准治疗方法失败的患者，临时使用 SEMS 放置可以解决近四分之三的胆道并发症；然而，支架迁移（33%）仍然是一个问题。
