Long-term Outcomes of Intraductal Fully Covered Self-Expandable Metal Stents for Anastomotic Biliary Strictures After Living Donor Liver Transplantation: Clinical and Economic Evaluation.

Objectives: Anastomotic biliary stricture (ABS) is a common complication following living donor liver transplantation (LDLT). Although plastic stents (PSs) have traditionally been the standard treatment, fully covered self-expandable metal stents (FCSEMSs) have recently gained attention because of their potential advantages. This study aimed to retrospectively analyze cases of ABS after LDLT that were treated with intraductal FCSEMSs (ID-FCSEMS) at our institution. Methods: This study included 46 adult patients who developed anastomotic bile duct stricture following LDLT. Twenty patients underwent ID-FCSEMS placement, and 22 patients underwent PS placement. The FCSEMSs were scheduled for removal after 16 weeks. Results: Placement of FCSEMSs was technically successful in all 20 patients. Early complications included cholangitis in five patients, whereas late complications included one case of stent migration and one case of obstructive cholangitis. Clinical success was achieved in 16 patients. Restenosis occurred in two patients. No significant differences were found between the FCSEMS group and the PS group in terms of reimbursement points (as defined by the Japanese medical fee schedule), number of hospitalizations, and total inpatient days. Conclusions: ID-FCSEMSs demonstrate a high success rate and favorable long-term outcomes for ABS after LDLT. Although no significant difference in cost reduction is observed, ID-FCSEMSs are a safe and effective therapeutic option for ABS.