Percutaneous tandem modified plastic stenting for post-transplant duct-to-duct biliary anastomotic strictures: long-term outcomes from a single-center cohort

PURPOSE This study aimed to evaluate the feasibility, safety, and long-term outcomes of a percutaneous technique using tandem modified plastic biliary stents (MPBSs) for benign duct-to-duct biliary anastomotic strictures after liver transplantation (LT). METHODS This retrospective single-center study included 48 recipients who underwent treatment between January 2011 and January 2025 after failure or ineligibility for endoscopic therapy. All patients underwent percutaneous placement of two MPBSs through a single transhepatic access. Technical success, symptomatic and biochemical response, procedure-related complications classified according to the Cardiovascular and Interventional Radiological Society of Europe system, and patency were evaluated. Patency was analyzed using the Kaplan–Meier method, and laboratory parameters were analyzed using the Wilcoxon signed-rank test. RESULTS Patients’ mean age was 33.3 ± 22.0 years. Technical success was achieved in all patients (100%), and symptomatic and biochemical improvement was documented in 46 of 48 patients (95.8%); assessment timing was not standardized. The mean stent indwelling time was 159 ± 42.9 days. Stent migration occurred in 3 patients (6.2%), and cholangitis in 5 patients (10.4%), with no major complications observed. The median primary patency was 1,689 days (95% confidence interval: 311–3,067 days). During follow-up, 29 of 48 patients (60.4%) required at least one additional biliary intervention. Total bilirubin levels decreased after the procedure (3.3 ± 1.9 vs. 0.8 ± 0.5 mg/dL, P < 0.01). CONCLUSION Percutaneous tandem MPBS placement is a reversible, metal-free salvage option for duct-to-duct biliary anastomotic strictures after LT. However, 60.4% of patients required additional biliary interventions during follow-up, underscoring the substantial reintervention burden associated with this approach. Its comparative efficacy relative to established alternatives, including biodegradable and removable covered metallic stents, remains undetermined. CLINICAL SIGNIFICANCE Percutaneous tandem modified plastic biliary stenting is a feasible metal-free salvage option for post-transplant anastomotic strictures when endoscopic treatment fails or is unfeasible. Further studies are needed to establish its efficacy relative to biodegradable and removable covered metallic stents.