Advertisement

European Radiology

, Volume 23, Issue 12, pp 3304–3310 | Cite as

Biodegradable biliary stent implantation in the treatment of benign bilioplastic-refractory biliary strictures: preliminary experience

  • Giovanni Mauri
  • Caterina Michelozzi
  • Fabio Melchiorre
  • Dario Poretti
  • Marco Tramarin
  • Vittorio Pedicini
  • Luigi Solbiati
  • Gianpaolo Cornalba
  • Luca Maria SconfienzaEmail author
Interventional

Abstract

Objectives

To evaluate feasibility, safety, and outcome of patients treated with biodegradable biliary stents for benign biliary stenosis refractory to other treatments.

Methods

Between March 2011 and September 2012, ten patients (seven men, three women; age 59 ± 7 years) with recurrent cholangitis due to postsurgical biliary stricture, previous multiple unsuccessful (two to five) bilioplasties, and unsuitability for surgical/endoscopic repair underwent percutaneous implantation of a biodegradable biliary stent. Patients were followed-up clinically and with ultrasound at 1, 3 and 6 months, and then at 6-month intervals.

Results

Stent implantation was always feasible. No immediate major or minor complications occurred. In all patients, 48-h cholangiographic control demonstrated optimal stent positioning and stenosis resolution. In a median follow-up time of 16.5 months (25th–75th percentiles = 11–20.25 months) no further invasive treatment was needed. Three patients experienced transient episodes of cholangitis. Neither re-stenosis nor dilatation of the biliary tree was documented during follow-up. No stent was visible at the 6-month follow-up.

Conclusions

Percutaneous placement of biodegradable biliary stents represents a new option in treating benign biliary stenoses refractory to treatment with bilioplasty. This technique seems to be feasible, effective and free from major complications. Further investigations are warranted to confirm our preliminary results.

Key Points

Percutaneous biodegradable stents can be used to treat benign biliary stenosis.

They can be used in patients refractory to bilioplasty.

The procedure for insertion appears free from major complication.

Biodegradable stents may represent an alternative device to covered expandable stents.

Keywords

Benign biliary stricture Bilioplasty Biodegradable stents Biliary tree Percutaneous biliary procedures 

References

  1. 1.
    Pitt HA, Kaufman SL, Coleman J, White RI, Cameron JL (1989) Benign postoperative biliary strictures. Operate or dilate? Ann Surg 210:417–425PubMedCrossRefGoogle Scholar
  2. 2.
    Köcher M, Cerná M, Havlík R, Král V, Gryga A, Duda M (2007) Percutaneous treatment of benign bile duct strictures. Eur J Radiol 62:170–174PubMedCrossRefGoogle Scholar
  3. 3.
    Yamamoto K, Yoshioka T, Furuichi K et al (2011) Experimental study of poly-L-lactic acid biodegradable stents in normal canine bile ducts. Cardiovasc Intervent Radiol 34:601–608PubMedCrossRefGoogle Scholar
  4. 4.
    Petrtýl J, Brůha R, Horák L, Zádorová Z, Dosedel J, Laasch HU (2010) Management of benign intrahepatic bile duct strictures: initial experience with polydioxanone biodegradable stents. Endoscopy 42:E89–E90PubMedCrossRefGoogle Scholar
  5. 5.
    Sabino MA, González S, Márquez L, Feijoo JL (2000) Study of the hydrolytic degradation of polydioxanone PPDX. Polym Degrad Stab 69:209–216CrossRefGoogle Scholar
  6. 6.
    Vondrys D, Elliott MJ, McLaren CA, Noctor C, Roebuck DJ (2011) First experience with biodegradable airway stents in children. Ann Thorac Surg 92:1870–1874PubMedCrossRefGoogle Scholar
  7. 7.
    Janík V, Horák L, Hnaníček J, Málek J, Laasch H-U (2011) Biodegradable polydioxanone stents: a new option for therapy-resistant anastomotic strictures of the colon. Eur Radiol 21:1956–1961PubMedCrossRefGoogle Scholar
  8. 8.
    Stivaros SM, Williams LR, Senger C, Wilbraham L, Laasch H-U (2010) Woven polydioxanone biodegradable stents: a new treatment option for benign and malignant oesophageal strictures. Eur Radiol 20:1069–1072PubMedCrossRefGoogle Scholar
  9. 9.
    Warshaw AL, Schapiro RH, Ferrucci JT Jr, Galdabini JJ (1976) Persistent obstructive jaundice, cholangitis, and biliary cirrhosis due to common bile duct stenosis in chronic pancreatitis. Gastroenterology 70:562–567PubMedGoogle Scholar
  10. 10.
    Shimada H, Endo I, Shimada K, Matsuyama R, Kobayashi N, Kubota K (2012) The current diagnosis and treatment of benign biliary stricture. Surg Today 42:1143–1153PubMedCrossRefGoogle Scholar
  11. 11.
    Mauri G, Sconfienza LM, Fiore B et al (2013) Post-surgical enteric fistula treatment with image-guided percutaneous injection of cyanoacrylic glue. Clin Radiol 68:59–63PubMedCrossRefGoogle Scholar
  12. 12.
    Cozzaglio L, Cimino M, Mauri G et al (2011) Percutaneous transhepatic biliary drainage and occlusion balloon in the management of duodenal stump fistula. J Gastrointest Surg 15:1977–1981PubMedCrossRefGoogle Scholar
  13. 13.
    Pedicini V, Poretti D, Mauri G et al (2010) Management of post-surgical biliary leakage with percutaneous transhepatic biliary drainage (PTBD) and occlusion balloon (OB) in patients without dilatation of the biliary tree: preliminary results. Eur Radiol 20:1061–1068PubMedCrossRefGoogle Scholar
  14. 14.
    Judah JR, Draganov PV (2007) Endoscopic therapy of benign biliary strictures. World J Gastroenterol 13:3531–3539PubMedGoogle Scholar
  15. 15.
    Zepeda-Gómez S, Baron TH (2011) Benign biliary strictures: current endoscopic management. Nat Rev Gastroenterol Hepatol 8:573–581PubMedCrossRefGoogle Scholar
  16. 16.
    van Boeckel PGA, Vleggaar FP, Siersema PD (2009) Plastic or metal stents for benign extrahepatic biliary strictures: a systematic review. BMC Gastroenterol 9:96PubMedCrossRefGoogle Scholar
  17. 17.
    Laukkarinen JM, Sand JA, Chow P et al (2007) A novel biodegradable biliary stent in the normal duct hepaticojejunal anastomosis: an 18-month follow-up in a large animal model. J Gastrointest Surg 11:750–757PubMedCrossRefGoogle Scholar
  18. 18.
    Mauri G, Sconfienza LM (2013) A few thoughts on “Interventional radiology in the management of benign biliary stenoses, biliary leaks and fistulas: a pictorial review”. Insights Imaging 4:253PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2013

Authors and Affiliations

  • Giovanni Mauri
    • 1
  • Caterina Michelozzi
    • 2
  • Fabio Melchiorre
    • 3
  • Dario Poretti
    • 4
  • Marco Tramarin
    • 4
  • Vittorio Pedicini
    • 4
  • Luigi Solbiati
    • 5
  • Gianpaolo Cornalba
    • 3
    • 7
  • Luca Maria Sconfienza
    • 1
    • 6
    Email author
  1. 1.Servizio di Radiologia, IRCCS Policlinico San DonatoMilanoItaly
  2. 2.Scuola di Specializzazione in RadiodiagnosticaUniversità degli Studi di MilanoMilanoItaly
  3. 3.Dipartimento di Diagnostica per Immagini, Ospedale San PaoloMilanoItaly
  4. 4.Servizio di Radiologia Oncologica e Interventistica, IRCCS Istituto Clinico HumanitasRozzano, MilanoItaly
  5. 5.Dipartimento Aziendale di Oncologia, Struttura Complessa di Radiologia Oncologica InterventisticaAzienda Ospedaliera Ospedale di Circolo di Busto ArsizioBusto Arsizio, VareseItaly
  6. 6.Dipartimento di Scienze Biomediche per la SaluteUniversità degli Studi di MilanoMilanoItaly
  7. 7.Dipartimento di Scienze della SaluteUniversità degli Studi di MilanoMilanoItaly

Personalised recommendations