Two Unique Complications of Lumen-Apposing Metal Stent Placement for Biliary Strictures Following Liver Transplant

Document Type

Conference Proceeding

Publication Date

10-25-2023

Publication Title

Am J Gastroenterol

Abstract

Introduction: We present 2 unique cases demonstrating potential complications of lumen-apposing metal stent (LAMS) placement after liver transplants to facilitate biliary drainage in a single center. Case Description/Methods: A 32-year old female with primary sclerosing cholangitis (PSC) presents with recurrent biliary strictures and cholangitis, necessitating liver transplant with a Roux-en-Y hepaticojejunostomy. Explant reveals a 3cm cholangiocarcinoma involving bile duct margins, Whipple procedure is performed. The course is complicated by severe intrahepatic biliary strictures. LAMS is placed from the blind end of the gastrojejunostomy to the upstream afferent jejunum. A week later, the patient experiences a small bowel obstruction treated surgically, and gastrointestinal (GI) bleeding secondary to trauma from the LAMS in the jejunum. Endoscopy reveals ulcer and clot. CT scan shows migration of the stent into the left abdominal bowel wall. The patient has recurrent cancer involving the abdomen and metastatic disease. The patient decides to be on hospice care and passes away 5 months later. A 60-year old female with alcoholic cirrhosis undergoes donation after circulatory death (DCD) liver transplant with a Roux-en-Y hepaticojejunostomy complicated by ischemic cholangiopathy and hepaticojejunostomy stricture. Percutaneous transhepatic cholangiography (PTC) drain is placed but removed due to patient discomfort, LAMS is considered to facilitate internal biliary drainage through stenting of the hepaticojejunostomy. However, the attempt is unsuccessful due to the distal flange of the LAMS deploying within the peritoneal cavity rather than the jejunum. The gastric perforation is repaired with an over-the-scope-clip (OTSC) device. CT is consistent with no extravasation of oral contrast, and the patient is hospitalized and treated with intravenous antibiotics. She is discharged home with an immunosuppression regimen and oral antibiotics. Subsequently PTC was placed with stabilization. Discussion: We present patients undergoing LAMS post-liver transplantation demonstrating potential for complications in this complex population. Complications from LAMS include peritoneum leaks, bleeds from trauma, or buried LAMS. However, they are often underreported due to unstandardized definitions of what constitutes complications.

Volume

118

Issue

10

First Page

S1516

Last Page

S1517

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