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    Benign Biliary Strictures, Leaks, and Stones: Clinical Application of Retrievable Fully Covered Self-Expandable Metallic Biliary Stent with an Alternative Retrieval String Fixation Method
    (Elsevier Science Inc, 2026) Kutlu, Ramazan; Dag, Nurullah; Saparbekov, Eldiiar; Yilmaz, Sezai
    Purpose: To evaluate the clinical application and outcomes of a percutaneously placed, retrievable, fully covered selfexpandable metallic stent with retrieval string with those of an alternative retrieval string fixation technique for the management of benign biliary conditions. Materials and Methods: This single-center, retrospective study included 87 patients who underwent percutaneous placement of retrievable fully covered self-expandable metallic stent with retrieval string between March 2020 and February 2025. Patients were categorized according to indication: anastomotic stricture (n = 30), bile leak (n = 41), and biliary stones (n = 16). The primary outcomes were technical and clinical success rates, with secondary outcomes including complication rates and long-term patency. Results: Technical success was achieved in 98% of procedures. Clinical success rates were 97% for anastomotic strictures (6-month follow-up), 91% for bile leaks, and 94% for biliary stones. Mean stent indwelling times were 3.0 +/- 0.8, 1.9 +/- 0.7, and 0.7 +/- 0.3 months, respectively. The estimated mean recurrence-free duration for anastomotic strictures was 41.7 months, with a 36-month patency rate of 67%. Stent migration occurred in 3.4% (3/87) of patients, while 1 retrieval string breakage and 3 cases of cholangitis were recorded. Conclusions: In this single-center observational cohort, percutaneous implantation of a retrievable fully covered selfexpandable metallic stent with retrieval string using an alternative fixation technique appears to be a safe and effective approach for the management of benign biliary conditions. In the study cohort, this technique was associated with favorable long-term patency in anastomotic strictures, favorable outcomes in bile leaks and stones, and a low rate of stent migration.
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    Nontarget Hemangioma Size Reduction after Bleomycin-Ethiodized Oil Embolization of Primary Hepatic Hemangioma
    (Elsevier Science Inc, 2025) Kutlu, Ramazan; Dag, Nurullah; Saparbekov, Eldiiar; Yagin, Fatma Hilal
    Purpose: To evaluate changes in nontarget hepatic hemangiomas, which are neither subjected to embolization nor targeted for treatment, following selective bleomycin-ethiodized oil transarterial chemoembolization (TACE) of a giant hepatic hemangioma. Materials and Methods: This single-center, retrospective study included 24 patients with nontarget hepatic hemangiomas distinct from primary giant hemangiomas treated with selective bleomycin-ethiodized oil TACE between 2009 and 2022. The size and volume of the lesions were assessed using computed tomography (CT) scans obtained before treatment and at 6, 12, and 24 months. Results: A significant reduction in the size of nontarget lesions (n = 34) was observed during follow-up (P < .05). Eighteen of 34 lesions (53%) showed a reduction in volume of 50% or greater. Overall clinical success rate for the primary lesion, defined as a significant size reduction and symptom improvement, was 96%. Logistic regression analysis showed no statistically significant association between demographic or primary lesion variables and changes in nontarget lesions (P = .901). Spearman correlation analysis revealed no significant relationship between changes in primary and nontarget lesions (P > .05). Conclusions: Bleomycin-ethiodized oil TACE of a giant hepatic hemangioma significantly reduced the size of untreated, nontarget hemangiomas. This may be related to systemic absorption of the chemotherapeutic agent, lymphatic dissemination, or an abscopal effect, although the exact mechanism remains unclear.