Self-expandable coated metal Danis stent as a bridge to liver transplantation
Eva Kostolná Orcid.org 1, Soňa Fraňková Orcid.org 1, Jan Šperl Orcid.org 1, Pavel Drastich Orcid.org 1, Tomáš Hucl Orcid.org 1, Julius Špičák Orcid.org 1
1 Klinika hepatogastroenterologie, Transplantcentrum, IKEM, Praha
We report a case of a 66-year-old female without substantial internal comorbidities. In September, 2010, she was treated for 3 weeks with amoxicillin at a dose of 1,000 mg daily for suspected Lyme disease (erythema migrans). Before the end of antibiotic treatment, the patient presented with jaundice and was diagnosed with advanced liver cirrhosis, which was very likely autoimmune in origin. The acute deterioration was ascribed to “acute-on-chronic” liver failure caused by drug toxicity. Owing to the progression of liver dysfunction, the patient was indicated for liver transplantation. The third day after enlistment, she presented with acute variceal bleeding. Treatment with endoscopic ligation failed and, thus, a self-expandable coated metal esophageal stent Danis was inserted. Because of the significant hepatic insufficiency and prolonged encephalopathy, it was not possible to perform TIPS and the Danis stent was maintained up until liver transplantation. The third day after ortotopic liver transplantation, and a total of 12 days after the introduction of the stent, the esophageal stent was extracted without complications and with only minimal superficial ulcerations visible on the mucosa. Seven years after the intervention, the patient still shows good liver graft function.
Keywordsself-expandable stent, liver transplantation, variceal bleeding
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