Interventional radiology has,
in liver transplanted patients suffering from anastomotic stenosis,
the objective of restoring and ensuring biliary patency,
avoiding an early surgical re-intervention [5].
The effectiveness of endoscopic techniques,
as an alternative to surgery,
has been confirmed by international studies,
which demonstrated success rates ranging between 63% and 80% after bilioplasty,
with or without stent placement [6]. However,
in some cases endoscopic approach is not preferred.
In these cases,
the method of choice becomes percutaneous.
Furthermore,
in some centers,
such as ours,
there is greater confidence in the interventional radiology approach.
In our study it has been demonstrated the combined efficacy of dilatation of the bile ducts procedures with balloon and eventual placement of biliary removable fully covered SEMS of almost 100% in the short-term (4 weeks) and about 80% at 36 months.
The better long-term patency outcome is achieved in patients who respond to first attempt to bilioplasty.
In this sense,
it has been shown that the percentage of successes is inversely proportional to the number of attempts to dilation.
For this reason,
when the stenosis does not yield until the third or fourth attempt,
it is appropriate to consider the possibility of a stent placement.
Results about bilioplasty are comparable with that of similar studies.
Roumillhac et al.
[7] found the primary patency after balloon dilatation to be 71% at 1 year and 61.2% after 2 years,
with the need for the placement of a stent in 5/22 patients.
The 1-year secondary patency rate was 88%. Koecher et al.
[8] attested the 1 year primary clinical success rate was 94%,
while the 2 and 3 years primary clinical success rate was respectively 83% and 77%. Sung et al.
[9] found percutaneous transhepatic balloon cholangioplasty successfully treated strictures in 39 of 76 (51.3%) cases. Righi et al.
[10] reported 33 patients,
who were clinically monitored for more than 12 months.
After one to three treatments 24/33 (73%) patients were stricture-free on follow-up.
A delayed stricture recurrence required a fourth percutaneous bilioplasty in 2/33 (6%) patients.
We tried to improve the performance of percutaneous biliary techniques also with stent insertion in case of bilioplasty failure as in Janssen et al.
[11].
They studied 99 patients; of 85 patients, with whom percutaneous treatment was completed,
11.8 % developed clinically relevant restenosis.
Treatments failed more often in patients who underwent multiple treatments.
The interest of today's literature focuses mainly on covered devices,
which would present the potential benefits of being able to be removed and to prevent the granulation tissue of the wall biliary infiltrate the lumen of the prosthesis [12].
Data leads us to think that the stents,
especially covered,
can be used primarily as a means of palliation or bridge to potential surgical revision.
A significant decrease of the enzymes of hepatic necrosis and cholestasis and of the symptoms was highlighted in the group of patients with resolution of stenosis.
Similar findings were described by Janssen et al.
[11]; they explained that the effectiveness not only manifests itself as patent bile ducts patency in a symptom-free patient,
but also in normalization of blood serum markers of liver function.
We conclude that PTBD with balloon dilation and,
possibly,
temporary stenting should be considered as treatment of choice in patients with post-transplantation benign biliary strictures.
In experienced hands,
it demonstrates reproducible good long-term effectiveness with a low complication rate.