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Background/Aims Fully covered self-expandable metal stents (FCSEMS) have demonstrated superior efficacy compared to multiple plastic stents (MPS) in the endoscopic management of postoperative benign biliary strictures (BBS). However, the potential for stent migration and suboptimal performance in proximal strictures remain significant clinical challenges. This study evaluates the long-term outcomes of a novel, shorter FCSEMS designed to address these limitations in BBS following hepatobiliary surgery. Methods In this retrospective study, 176 patients who underwent shorter FCSEMS placement for BBS after hepatobiliary surgery, including living donor liver transplantation (LDLT) and deceased donor liver transplantation (DDLT), were followed for a minimum of 3 years post-stent removal. The shorter FCSEMS were designed for intraductal placement to mitigate migration risk and cystic duct occlusion. Primary outcomes included technical success, stricture resolution, recurrence rates, and complications. Results Technical success was achieved in 100% of cases. Mean follow-up duration post-FCSEMS removal was 5.9 years (range: 3.0-8.7). BBS recurrence was observed in 27.8% (49/176) of patients. Mean time to recurrence was 1.4 years for LDLT (95% CI: 1.1-1.7), 2.3 years for DDLT (95% CI: 1.9-2.7), 1.5 years for cholecystectomy (95% CI: 1.2-1.8), and 1.7 years for hepatic lobectomy (95% CI: 1.4-2.0). Early complications (within 1 month) included cholangitis (3.4%), pancreatitis (1.1%), and metastases (2.3%). Conclusion Short FCSEMS demonstrated high efficacy and safety in treating BBS following hepatobiliary surgery, with favorable long-term outcomes. Despite the limitations inherent to retrospective designs, these results support the use of short FCSEMS for post-hepatobiliary surgery BBS. Multicenter prospective studies are warranted to validate these findings and explore potential benefits across different patient subgroups. [ABSTRACT FROM AUTHOR]

Background: Concurrent chemoradiation therapy (CCRT) followed by hepatic arterial infusional chemotherapy (HAIC) was reported to be effective for advanced hepatocellular carcinoma (HCC) with portal vein thrombosis. However, transarterial chemoembolization (TACE) is not preferred in this setting. The aim of this study was to assess the factors affecting survival after CCRT, including additional TACE during repeated HAIC.Methods: Thirty-eight patients who underwent CCRT as the initial treatment for Barcelona Clinic Liver Cancer stage C HCC with vascular invasion between 2009 and 2016 were reviewed retrospectively. During CCRT, 5-fluorouracil (5-FU) was infused via chemoport during the first and last five days of five weeks of external beam radiation therapy. After CCRT, repeated HAIC with cisplatin and 5-FU was performed monthly. Nineteen patients (50%) underwent additional TACE between repeated HAICs. Factors related to overall survival and progression free survival (PFS) were analyzed.Results: The mean age of patients was 55 years (male:female, 33:5). Underlying liver diseases were hepatitis B, hepatitis C and non-B/C in 29, 1 and 8 patients, respectively. The median radiation dose was 4500 cGy. The objective response (OR) rate at one months after CCRT was 36.8%. The median PFS was 7.4 (range, 1.8 - 32.1) months. The median overall survival was 11.6 (range 2.8-65.7) months. Achieving an OR after CCRT (hazard ratio [HR], 0.028; P < 0.001), additional TACE (HR, 0.134, P < 0.001), and further rounds of HAIC (HR, 0.742, P = 0.001) were independent significant factors related to overall survival. The overall survival duration of patients with an OR after CCRT (median 44.2 vs. 6.6 months, P < 0.001) and additional TACE (median 19.8 vs. 9.1 months, P = 0.001) were significantly greater than those without an OR after CCRT or additional TACE.Conclusion: Patients who achieved an OR after CCRT, underwent additional TACE, and were subjected to repeated rounds of HAIC following CCRT showed better survival after CCRT for advanced stage of HCC with vascular invasion. A further prospective study is needed to confirm the positive effect of additional TACE after CCRT. [ABSTRACT FROM AUTHOR]

Background/Aims In the treatment of anastomotic biliary stricture (ABS), non-surgical methods have a high success rate. Recent studies reported that fully covered self-expandable metal stent (FCSEMS) is useful in advanced ABS. However, there are limits that migration rate is high and the treatment rate of high-level stricture is low. In this study, we investigated the efficacy of modified short removable FCSEMS with an anti-migration design for high-level ABS. Methods FCSEMS insertion was performed endoscopically on patients with high-level ABS after a biliary operation. The FCSEMS was maintained initially three months and exchanged every three months until the stricture was resolved. After removal of the FCSEMS, complications and recurrence were accessed during follow-up. Results A total of 71 patients with a median age of 58 years. The underlying diseases were hepatocellular carcinoma (53.5%), liver cirrhosis (26.8%), hepatic failure (7%) and gallbladder stone (8.5%). The types of the previous operation were living donor liver transplantation (77.5%), deceased donor liver transplantation (8.5%), liver lobectomy (11.3%) and cholecystectomy alone (2.8%). The previous procedures to resolve ABS were endoscopic retrograde cholangiopancreatography with plastic stent (39.4%), percutaneous transhepatic biliary drainage (26.8%) and both (28.2%). The technical success rate was 100%, and the clinical success rate was 95.7%. The recurrence rate was 22.5%, and the complication rate was 14%. All the stents were removable, and stent migration was noted in 4 patients (5.6%). Conclusions The newly designed FCSEMS is a potentially feasible and effective for the treatment in patients with high-level ABS after a biliary operation. [ABSTRACT FROM AUTHOR]