Use of Fully Covered Self-Expandable Stent in Biliary Complications After Liver Transplantation: A Case Series L.M. Marín-Gómez, S. Sobrino-Rodríguez, J.M. Álamo-Martínez, G. Suárez-Artacho, C. Bernal-Bellido, J. Serrano-Díaz-Canedo, J. Padillo-Ruiz, and M.A. Gómez-Bravo ABSTRACT Aims. To present our case series of fully covered self-expandable metallic stents (FCSESs) placed to treat biliary stenosis after liver transplantation and leakage after failure of plastic stenting. Materials and methods. We retrospectively reviewed the courses of patients who had undergone liver transplantation with a biliary complication that was treated by an FCSES installed by endoscopic retrograde cholangiopancreatography. We evaluated the following variables: gender, age, indication for transplantation, time between transplant and diagnosis of the complication, number of plastic stents placed before the FCSES, and procedure-related complications. Results. From April 2008 to March 2010, 11 patients who had undergone a duct-to-duct anastomosis suffered posttransplant biliary stenosis or leakage with failure of endoscopic treatment using a plastic biliary stent: Namely, eight cases of stenosis and three of biliary leaks. Three patients underwent a papillotomy to place the FCSES, with no significant morbidity. No severe complications were observed after the endoscopic treatments; two patients developed mild pancreatitis; two, hyperamylasemia; and one, mild biliary sepsis. We removed the FCSES after a mean of 280 (range = 173–310) days. Five patients lost the FCSES spontaneously. One patient underwent a choledocojejunostomy and two are waiting biliary surgery. Conclusion. We avoided cholangiojejunostomy in 6/9 cases (not including the two deaths). Papillotomy did not engender a greater morbidity. The spontaneous loss of the stent is a problem that need to be resolved. D ESPITE IMPROVED SURGICAL TECHNIQUES, biliary complications are still the most frequent cause of morbidity after liver transplantation (8%–35%). In fact, they can be considered the Achilles’ heel of liver transplan- tation (OLT). The most common complication is an anas- tomotic stricture, followed by a biliary leakage. 1 Endoscopic management of biliary complications after OLT has a success rate of 70% to 80%. 2 These biliary complications can be treated by endoscopic retrograde cholangiopancre- atography (ERCP) in cases of a duct-to-duct anastomosis, allowing their evaluation and management. If endoscopic therapy fails, surgical treatment is the current alternative solution. Patients successfully responding to endoscopic therapy still bear the risk of a recurrent biliary stricture. 3 Recently, satisfactory results have been achieved with fully covered self-expandable biliary stent, (FCSESs), 4,5 encour- aging their use to treat post-OLT biliary complications. 6,7 Herein we have presented a case series of FCSESs placed to treat post-OLT biliary stenosis and leakage after failure of plastic stenting. From the Liver Transplantation Unit, Digestive Surgery Depart- ment (L.M.M.-G., J.M.A.M., G.S.-A., C.B.B., J.J.D.-C., J.P.R., M.A.G.-B.), and Digestive Endoscopy Unit, Gastroenterology and Hepatology Department (S.S.R.), Universitary Hospital Vir- gen del Rocio, Sevilla, Spain. Address reprint requests to Dr D. Luis M. Marín-Gómez, Liver Transplantation Unit, Digestive Surgery Department, 3 a planta de la Residencia General, HH.UU. Virgen del Rocío, C/Manuel Siurot, s/n, Sevilla 41018, Spain. E-mail: marinlm@hotmail.com © 2010 Published by Elsevier Inc. 0041-1345/–see front matter 360 Park Avenue South, New York, NY 10010-1710 doi:10.1016/j.transproceed.2010.08.023 Transplantation Proceedings, 42, 2975–2977 (2010) 2975