Journal of Gastroenterology

, Volume 48, Issue 9, pp 1097–1104 | Cite as

Endoscopic stent placement above the intact sphincter of Oddi for biliary strictures after living donor liver transplantation

  • Akira Kurita
  • Yuzo Kodama
  • Ryuki Minami
  • Yojiro Sakuma
  • Katsutoshi Kuriyama
  • Wataru Tanabe
  • Yuji Ohta
  • Takahisa Maruno
  • Masahiro Shiokawa
  • Yugo Sawai
  • Norimitsu Uza
  • Shujiro Yazumi
  • Atsushi Yoshizawa
  • Shinji Uemoto
  • Tsutomu Chiba
Original Article—Liver, Pancreas, and Biliary Tract


Background and study aims

Biliary complications are one of the most serious morbidities after liver transplantation. Inside-stent is a plastic stent placed above the sphincter of Oddi without endoscopic sphincterotomy against biliary strictures. Our aims were to analyze the long-term efficacy of inside-stent placement in patients with biliary stricture after living donor liver transplantation.

Patients and methods

Ninety-four patients who experienced biliary stricture that employed duct-to-duct reconstruction were treated with inside-stent placement. Treatment outcomes, including stricture resolution, recurrence, inside-stent patency, and morbidity rate were evaluated retrospectively.


Ninety-two patients could be evaluated. Resolution of stricture was eventually observed in 81 of 92 patients with an average of 1.4 sessions of endoscopic retrograde cholangiography. Of the 81 patients who achieved the resolution of the stricture, recurrent biliary stricture that required intervention occurred in 8 patients. Conversely, stricture remission was achieved 73 patients (90.1 %) during 53 months follow-up after stent removal. Median duration of patency of the initial stent was 189 (range 2–1228) days. Stent dislocation occurred in 10 patients. Adverse event related to inside-stent placement was pancreatitis in 18 cases (mild 13, moderate 5).


Inside-stent placement achieved long-term patency and high remission rate in patients with biliary stricture after liver transplantation.


Biliary drainage Living donor liver transplantation Stricture Inside-stent 



Living donor liver transplantation


Roux-en-Y hepaticojejunostomy


Deceased donor liver transplantation


Percutaneous transhepatic biliary drainage


Endoscopic sphincterotomy


Endoscopic retrograde cholangiography


Non-anastomotic stricture


Conflict of interest

The authors of this manuscript have no conflicts of interest to disclose.


  1. 1.
    Sossenheimer M, Slivka A, Carr-Locke D. Management of extrahepatic biliary disease after orthotopic liver transplantation: review of the literature and results of a multicenter survey. Endoscopy. 1996;28(7):565–71.PubMedCrossRefGoogle Scholar
  2. 2.
    Kasahara M, Egawa H, Takada Y, Oike F, Sakamoto S, Kiuchi T, et al. Biliary reconstruction in right lobe living-donor liver transplantation: comparison of different techniques in 321 recipients. Ann Surg. 2006;243(4):559–66.PubMedCrossRefGoogle Scholar
  3. 3.
    Seo JK, Ryu JK, Lee SH, Park JK, Yang KY, Kim YT, et al. Endoscopic treatment for biliary stricture after adult living donor liver transplantation. Liver Transpl. 2009;15(4):369–80.PubMedCrossRefGoogle Scholar
  4. 4.
    Trotter JF, Wachs M, Everson GT, Kam I. Adult-to-adult transplantation of the right hepatic lobe from a living donor. N Engl J Med. 2002;346:1074–82.PubMedCrossRefGoogle Scholar
  5. 5.
    Busuttil RW, Farmer DG, Yersiz H, Hiatt JR, McDiarmid SV, Goldstein LI, et al. Analysis of long-term outcomes of 3200 liver transplantations over two decades: a single-center experience. Ann Surg. 2005;241:905–16.PubMedCrossRefGoogle Scholar
  6. 6.
    Graziadei IW, Schwaighofer H, Koch R, Nachbaur K, Koenigsrainer A, Margreiter R, et al. Long-term outcome of endoscopic treatment of biliary strictures after liver transplantation. Liver Transpl. 2006;12(5):718–25.PubMedCrossRefGoogle Scholar
  7. 7.
    Hisatsune H, Yazumi S, Egawa H, Asada M, Hasegawa K, Kodama Y, et al. Endoscopic management of biliary strictures after duct-to-duct biliary reconstruction in right-lobe living-donor liver transplantation. Transplantation. 2003;76(5):810–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Yazumi S, Yoshimoto T, Hisatsune H, Hasegawa K, Kida M, Tada S, et al. Endoscopic treatment of biliary complications after right-lobe living-donor liver transplantation with duct-to-duct biliary anastomosis. J Hepatobiliary Pancreat Surg. 2006;13(6):502–10.PubMedCrossRefGoogle Scholar
  9. 9.
    Park JS, Kim MH, Lee SK, Seo DW, Lee SS, Han J, et al. Efficacy of endoscopic and percutaneous treatments for biliary complications after cadaveric and living donor liver transplantation. Gastrointest Endosc. 2003;57(1):78–85.PubMedCrossRefGoogle Scholar
  10. 10.
    Tabibian JH, Asham EH, Han S, Saab S, Tong MJ, Goldstein L, et al. Endoscopic treatment of postorthotopic liver transplantation anastomotic biliary strictures with maximal stent therapy. Gastrointest Endosc. 2010;71(3):505–12.PubMedCrossRefGoogle Scholar
  11. 11.
    Chaput U, Scatton O, Bichard P, Ponchon T, Chryssostalis A, Gaudric M, et al. Temporary placement of partially covered self-expandable metal stents for anastomotic biliary strictures after liver transplantation: a prospective, multicenter study. Gastrointest Endosc. 2010;72(6):1167–74.PubMedCrossRefGoogle Scholar
  12. 12.
    Mahajani RV, Cotler SJ, Uzer MF. Efficacy of endoscopic management of anastomotic biliary strictures after hepatic transplantation. Endoscopy. 2000;32:943–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Rossi AF, Grosso C, Zanasi G, Gambitta P, Bini M, De Carlis L, et al. Long-term efficacy of endoscopic stenting in patients with stricture of the biliary anastomosis after orthotopic liver transplantation. Endoscopy. 1998;30:360–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Schilling D, Rink G, Arnold JC, Benz C, Adamek HE, Jakobs R, et al. Prospective, randomized, single-center trial comparing 3 different 10 F plastic stents in malignant mid and distal bile duct strictures. Gastrointest Endosc. 2003;58(1):54–8.PubMedCrossRefGoogle Scholar
  15. 15.
    England RE, Martin DF, Morris J, Sheridan MB, Frost R, Freeman A, et al. A prospective randomised multicentre trial comparing 10 Fr Teflon Tannenbaum stents with 10 Fr polyethylene Cotton-Leung stents in patients with malignant common duct strictures. Gut. 2000;46(3):395–400.PubMedCrossRefGoogle Scholar
  16. 16.
    Costamagna G, Pandolfi M, Mutignani M, Spada C, Perri V. Long-term results of endoscopic management of postoperative bile duct strictures with increasing numbers of stents. Gastrointest Endosc. 2001;54(2):162–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Kulaksiz H, Weiss KH, Gotthardt D, Adler G, Stremmel W, Schaible A, et al. Is stenting necessary after balloon dilation of post-transplantation biliary strictures? Results of a prospective comparative study. Endoscopy. 2008;40:746–51.PubMedCrossRefGoogle Scholar
  18. 18.
    Cotton PB, Eisen GM, Aabakken L, Baron TH, Hutter MM, Jacobson BC, et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc. 2010;71:446–54.PubMedCrossRefGoogle Scholar
  19. 19.
    Kato H, Kawamoto H, Tsutsumi K, Harada R, Fujii M, Hirao K, et al. Long-term outcomes of endoscopic management for biliary strictures after living donor liver transplantation with duct-to-duct reconstruction. Transpl Int. 2009;22(9):914–21.PubMedCrossRefGoogle Scholar
  20. 20.
    Zoepf T, Maldonado-Lopez EJ, Hilgard P, Schlaak J, Malago M, Broelsch CE, Treichel U, Gerken G. Endoscopic therapy of posttransplant biliary stenoses after right-sided adult living donor liver transplantation. Clin Gastroenterol Hepatol. 2005;3(11):1144–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Chang JH, Lee IS, Choi JY, Yoon SK, Kim DG, You YK, Chun HJ, Lee DK, Choi MG, Chung IS. Biliary stricture after adult right-lobe living-donor liver transplantation with duct-to-duct anastomosis: long-term outcome and its related factors after endoscopic treatment. Gut Liver. 2010;4(2):226–33.PubMedCrossRefGoogle Scholar
  22. 22.
    Hu B, Gao DJ, Yu FH, Wang TT, Pan YM, Yang XM. Endoscopic stenting for post-transplant biliary stricture: usefulness of a novel removable covered metal stent. J Hepatobiliary Pancreat Sci. 2011;18(5):640–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Weickert U, Venzke T, König J, Janssen J, Remberger K, Greiner L. Why do bilioduodenal plastic stents become occluded? A clinical and pathological investigation on 100 consecutive patients. Endoscopy. 2001;33(9):786–90.PubMedCrossRefGoogle Scholar
  24. 24.
    Leung JW, Liu YL, Chan RC, Ling TK, Cheng AF. Effects of adherence factors and human bile on bacterial attachment and biliary stent blockage: an in vitro study. Gastrointest Endosc. 2002;56(1):72–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Leung JW, Liu YL, Desta TD, Libby ED, Inciardi JF, Lam K. In vitro evaluation of antibiotic prophylaxis in the prevention of biliary stent blockage. Gastrointest Endosc. 2000;51(3):296–303.PubMedCrossRefGoogle Scholar
  26. 26.
    Leung JW, Libby ED, Morck DW, McKay SG, Liu Y, Lam K, et al. Is prophylactic ciprofloxacin effective in delaying biliary stent blockage? Gastrointest Endosc. 2000;52(2):175–82.PubMedCrossRefGoogle Scholar
  27. 27.
    Pfau PR, Kochman ML, Lewis JD, Long WB, Lucey MR, Olthoff K, et al. Endoscopic management of postoperative biliary complications in orthotopic liver transplantation. Gastrointest Endosc. 2000;52(1):55–63.PubMedCrossRefGoogle Scholar
  28. 28.
    Jue TL, Imperial JC. Management of post-liver-transplant biliary strictures: a work in progress. Gastrointest Endosc. 2008;67(6):886–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Thuluvath PJ, Pfau PR, Kimmey MB, Ginsberg GG. Biliary complications after liver transplantation: the role of endoscopy. Endoscopy. 2005;37:857–63.PubMedCrossRefGoogle Scholar
  30. 30.
    Alazmi WM, Fogel EL, Watkins JL, McHenry L, Tector JA, Fridell J, et al. Recurrence rate of anastomotic biliary strictures in patients who have had previous successful endoscopic therapy for anastomotic narrowing after orthotopic liver transplantation. Endoscopy. 2006;38:571–4.PubMedCrossRefGoogle Scholar
  31. 31.
    Itoi T, Kasuya K, Abe Y, Isayama H. Endoscopic placement of a new short-term biodegradable pancreatic and biliary stent in an animal model: a preliminary feasibility study. J Hepatobiliary Pancreat Sci. 2011;18(3):463–7.PubMedCrossRefGoogle Scholar
  32. 32.
    Geoghegan JG, Branch MS, Costerton JW. Biliary stents occlude earlier if the distal tip is in the duodenum in dogs. Gastrointest Endosc. 1991;37:257.Google Scholar
  33. 33.
    Pedersen FM, Lassen AT, Schaffalitzky de Muckadell OB. Randomized trial of stent placed above and across the sphincter of Oddi in malignant bile duct obstruction. Gastrointest Endosc. 1998;48(6):574–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Uchida N, Tsutsui K, Ezaki T, Fukuma H, Kamata H, Kobara H, et al. Estimation of the stent placement above the intact sphincter of Oddi against malignant bile duct obstruction. J Gastroenterol. 2005;40(3):291–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Japan 2013

Authors and Affiliations

  • Akira Kurita
    • 1
  • Yuzo Kodama
    • 1
  • Ryuki Minami
    • 1
  • Yojiro Sakuma
    • 1
  • Katsutoshi Kuriyama
    • 1
  • Wataru Tanabe
    • 1
  • Yuji Ohta
    • 1
  • Takahisa Maruno
    • 1
  • Masahiro Shiokawa
    • 1
  • Yugo Sawai
    • 1
  • Norimitsu Uza
    • 1
  • Shujiro Yazumi
    • 3
  • Atsushi Yoshizawa
    • 2
  • Shinji Uemoto
    • 2
  • Tsutomu Chiba
    • 1
  1. 1.Department of Gastroenterology and HepatologyKyoto University Graduate School of MedicineKyotoJapan
  2. 2.Department of Hepato-Pancreato-Biliary Surgery and TransplantationKyoto UniversityKyotoJapan
  3. 3.Digestive Disease CenterKitano HospitalOsakaJapan

Personalised recommendations