Percutaneous placement of customized plastic biliary stents with internal–external drainage in liver transplant recipients with Roux-en-Y hepaticojejunostomy: A retrospective study of a novel approach for managing benign biliary strictures

To evaluate the feasibility, safety, and clinical efficacy of a novel percutaneous technique for treating benign biliary strictures in liver transplant (LT) recipients with Roux-en-Y hepaticojejunostomy, utilizing a handmade plastic biliary stent (PBS) in combination with an internal-external biliary drainage catheter. This retrospective study included 16 LT recipients with Roux-en-Y hepaticojejunostomy who developed benign biliary strictures and were treated percutaneously between January 2011 and January 2024. A customized PBS, created from a drainage catheter and affixed to an internal-external biliary catheter using a surgical suture, was deployed via a single transhepatic approach. Outcomes assessed included technical and clinical success, complication rates, stent patency, and the need for surgical revision. Technical success was achieved in all patients (100%), and initial clinical improvement was observed in all cases following percutaneous intervention. During follow-up, two patients required surgical revision and metallic stenting because of a persistent resistant stricture. Following PBS placement, the mean follow-up duration was 1,247 days (SD: 887; range: 195–1,934 days). The mean primary stent patency duration was 952 days. No major complications or stent migrations occurred. Minor complications were observed in three patients (18.7%) and were managed conservatively. This novel percutaneous technique, combining a handmade plastic stent with internal-external drainage through a single tract, offers a feasible, clinically useful, and encouraging long-term patency for managing post-transplant biliary strictures in patients with Roux-en-Y reconstruction. Its technical simplicity, high success rate, and suitability for complex anatomies make it a potential alternative when endoscopic access is not feasible.