Introduction: This study aims to evaluate the effectiveness of a novel technique using an internal-external biliary drainage catheter and a homemade internal plastic stent, both inserted simultaneously via percutaneous access, for treating biliary strictures in liver transplant patients with hepaticojejunostomy.
Materials and Methods: Seventeen patients included in the study underwent balloon dilatation, and an internal-external biliary drainage catheter was placed for biliary anastomotic stenosis at first. In a follow-up procedure, an internal plastic stent was placed dually along with a drainage catheter from the same access. The plastic stent is derived from the biliary drainage catheter by modifying the distal end of the catheter to fit the required size and removing the proximal part. Two stiff wires are placed from the transhepatic access to intestinal segment. Firstly, stent is placed over one of the wires across the anastomosis then internal-external biliary drainage catheter is placed side by side with the internal stent. This method effectively doubles the diameter at the site of anastomosis or stenosis using an access point only one catheter wide. The patient is followed at least six weeks with this dual system. The drainage catheter and internal plastic stent were removed when follow-up cholangiography showed improved passage with no recurrence of symptoms or elevation of biochemical markers.
Results: Technical success was achieved in all 17 (100%) patients after percutaneous transhepatic treatment. Clinical success was achieved in 13 (77%) patients, and drainage catheters with internal plastic stents were removed after a mean period of 3.1 months (range, 1.5–10.8 months). During the follow-up, the primary patency rates were 76%, 94% at 6 and 12 months, respectively. Four (%23) of the 17 patients developed recurrent symptoms after the removal of both internal plastic stent and drainage catheter.
Conclusion: Dual placement of an internal plastic stent and an internal-external biliary drainage catheter is a safe and effective method of overcoming persistent anastomotic stenosis in liver transplant patients with hepaticojejunostomy.