Biodegradable stents appear safe and effective for treating narrowing of the bile ducts in children after liver transplants, according to research presented December 2 at the RSNA meeting.
The findings are from a 10-year study involving five hospitals in Italy that assessed the placement of the stents in 102 patients who were a median age of five years old, noted interventional radiologist Paolo Marra, MD, of Papa Giovanni XXIII Hospital in Bergamo.
“Biodegradable stents may improve the treatment of patients who are resistant to conventional therapy or with recurrent strictures and also may improve their quality of life,” Marra told attendees.
Biodegradable biliary stents are commonly used to treat benign, noncancerous biliary strictures in adults due to scarring after liver transplants and other causes. The procedure is an alternative to draining the duct to prevent the backup of bile while the bile duct heals and involves inserting a stent at the site to widen it, which allows it to remodel while it heals, Marra explained. There is limited data regarding its use in pediatric patients, he noted.
To bridge the knowledge gap, Marra and colleagues assessed outcomes after the procedure among pediatric patients. Out of the 102 patients, 52 were males and 50 were females. Patients had undergone liver transplants at a median age of one year old, and subsequently developed strictures.
At a median age of 5 years old, all patients underwent the procedure using self-expandable polydioxanone-based stents. The researchers analyzed stricture features and treatment timing, as well as freedom from stricture recurrence and complications.
At baseline, 58 of the 102 patients (57%) had a stricture length ≥10 mm, and 53/102 (52%) had intrahepatic duct involvement. Stenting was done after a median of 55 days from the patients’ last biliary drainage.
According to the results, the procedure was technically successful in 101 of 102 (99%) cases, with low-grade complications occurring in 19 (19%). During a median follow-up of 793 days (IQR = 1,188.5 days), 24/102 (24%) patients had stricture recurrence with an estimated median time to recurrence of 2,915 days.
“Biodegradable stents appear safe and effective for treating biliary strictures after pediatric liver transplantation,” Marra said.
Ultimately, current standard procedures for these patients involve balloon bilioplasty (balloon dilation), which is temporary, or drainage of the duct to prevent the backup of bile while the bile duct heals, Marra noted. Drainage, however, requires patients to carry and maintain external devices for months, and this significantly impacts their quality of life, he added.
Future research will be conducted to ascertain whether certain factors contribute to failure, which should inform patient selection and the optimal timing for stenting in these patients, Marra said.
“Biodegradable biliary stents may improve the management of biliary strictures after pediatric liver transplantation with a positive impact on outcomes and less invasiveness,” he concluded.
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