Endoscopic Management of Post–Liver Transplantation Biliary Strictures With the Use of Fully Covered Metallic Stents

Jiménez‐Pérez, Miguel; Simon, J.-M.; Campos, Asunción Durán; Grande, Rocío González; López, J.M. Rodrigo; Gonzalez, Rafael

doi:10.1016/j.transproceed.2016.09.008

Cited by 12 publications

(12 citation statements)

References 23 publications

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“…11,23,[33][34][35][36][37] The length of the cSEMS indwell period is not yet standardised but most authors have suggested 3-6 months. 25,38 Accordingly, to the variability of the indwell period of the cSEMS among centres, the median stent permanence is similar between the group with migration and the one without.…”

Section: Discussionmentioning

confidence: 76%

“…When compared to multiple plastic stents, the potential benefits of the use of a fully covered SEMS to dilate benign biliary strictures are the low technical difficulty and procedural time and the need for 2 ERCPs only, one to insert and the second to remove the stent. 9,24,25 Stricture resolution rates after cSEMS removal are reported up to 80%. 5,26,27 To date, there are four RCTs published on the treatment of anastomotic strictures after liver transplantation, which compare MPS vs. cSEMS.…”

Section: Discussionmentioning

confidence: 99%

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Migration rate using fully covered metal stent in anastomotic strictures after liver transplantation: Results from the BASALT study group

Conigliaro

Pigò

Bertani

et al. 2022

Liver International

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Background and Study Aim:The traditional endoscopic therapy of anastomotic strictures (AS) after orthotopic liver transplantation (OLT) is multiple ERCPs with the insertion of an increasing number of plastic stents side-by-side. Fully covered selfexpanding metal stents (cSEMS) could be a valuable option to decrease the number of procedures needed or non-responders to plastic stents. This study aims to retrospectively analyse the results of AS endoscopic treatment by cSEMS and to identify any factors associated with its success.Patients and Methods: Ninety-one patients (mean age 55.9 ± 7.6 SD; 73 males) from nine Italian transplantation centres, had a cSEMS positioned for post-OLT-AS between 2007 and 2017. Forty-nine (54%) patients were treated with cSEMS as a second-line treatment.Results: All the procedures were successfully performed without immediate complications. After ERCP, adverse events occurred in 11% of cases (2 moderate pancreatitis and 8 cholangitis). In 49 patients (54%), cSEMSs migrated. After cSEMS removal, 46 patients (51%) needed further endoscopic (45 patients) or radiological (1 patient) treatments to solve the AS. Lastly, seven patients underwent surgery. Multivariable stepwise logistic regression showed that cSEMS migration was the only factor associated Handling editor: Luca Valenti

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Migration rate using fully covered metal stent in anastomotic strictures after liver transplantation: Results from the BASALT study group

Conigliaro

Pigò

Bertani

et al. 2022

Liver International

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“…These procedures were used as secondary intervention in five of the studies . The other five studies included SEMS as both primary and secondary treatments in a total of 304 patients with an age range of 49–59 years. The mean number of ERCP procedures per patient was between 2.7 and 3.7 (Table ).…”

Section: Resultsmentioning

confidence: 99%

“…The quality of the retrospective cohort study according to the NOS was 7/9, and the risk of bias was classified as low (Table S1). Based on the NICE checklist, eight case series received a score of 7/8 , seven received a grade of 6/8 , nine case series received a grade of 5/8 [] and the other five received a grade of 4/8 (Fig. S1).…”

Section: Resultsmentioning

confidence: 99%

Endoscopic treatment of anastomotic biliary stricture after adult deceased donor liver transplantation with multiple plastic stents versus self-expandable metal stents: a systematic review and meta-analysis

et al. 2017

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Anastomotic biliary strictures (ABSs) occur in up to 15% of patients after liver transplantation (LT). The aim of this study was to compare the efficacy and safety of self-expandable metal stents (SEMS) versus multiple plastic stents (MPS). Databases were searched through April 2017. The outcome measures were technical success, stricture resolution, recurrence and complications. We synthesized the findings descriptively and performed a meta-analysis. Three randomized controlled trials and one retrospective cohort study were identified, including 179 MPS and 119 SEMS patients. Outcome data were pooled in a meta-analysis that showed an advantage of SEMS in terms of the number of ERCP procedures (mean difference: 1.69 ERCP; 95% CI, 1-2.39; P < 0.00001) and treatment days (mean difference: 40.2 days; 95% CI, 3.9-76.4; P = 0.03), with no differences in terms of ABS resolution or recurrence. Fourteen case series reported MPS outcomes and fifteen reported SEMS outcomes, including 647 and 419 patients, respectively. Based on low-quality evidence, we cannot draw any reliable conclusions on the superiority of MPS or SEMS strategies. Even though shorter treatment times and fewer ERCP procedures support the use of SEMS, whether one technique has well-defined advantages over the other remains unclear.

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“…The initial premise is that only two ERCPs are needed to treat the biliary anastomotic stricture after OLTX: one to place the metallic stent and another to remove it, leading to greater acceptance by patients and potentially lesser costs and fewer AEs 13 . Case series with CSEMS have already demonstrated the safety of these devices, and few studies on this topic have shown similar rates of treatment success, recurrence, and AEs between the two types of treatment 14 15 16 17 .…”

Section: Introductionmentioning

confidence: 99%

Metallic vs plastic stents to treat biliary stricture after liver transplantation: a systematic review and meta-analysis based on randomized trials

et al. 2018

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Background and study aims The first-line approach to anastomotic biliary stricture after orthotopic liver transplantation (OLTX) involves endoscopic retrograde cholangiopancreatography (ERCP). The most widely used technique is placement of multiple plastic stents, but discussions are ongoing on the benefits of fully-covered self-expandable metallic stents (FCEMS) in this situation. This study aimed to compare results from use of plastic and metal stents to treat biliary stricture after transplantation. Patients and methods Searches were performed in the Medline, EMBASE, SciELO/LILACS, and Cochrane databases, and only randomized studies comparing the two techniques were included in the meta-analysis. Results Our study included four randomized clinical trials totaling 205 patients. No difference was observed between the stricture resolution rate (RD: 0.01; 95 %CI [−0.08 – 0.10]), stricture recurrence (RD: 0.13; 95 %CI [−0.03 – 0.28]), and adverse events (RD: −0.10; 95 %CI [−0.65 – 0.44]) between the plastic and metallic stent groups. The metallic stent group demonstrated benefits in relation to the number of ERCPs performed (MD: −1.86; 95 %CI [−3.12 to −0.6]), duration of treatment (MD: −105.07; 95 %CI [−202.38 to −7.76 days]), number of stents used (MD: −10.633; 95 %CI [−20.82 to −0.44]), and cost (average $ 8,288.50 versus $ 18,580.00, P < 0.001). Conclusions Rates of resolution and recurrence of stricture are similar, whereas the number of ERCPs performed, number of stents used, duration of treatment, and costs were lower in patients treated with FCEMS, which shows that this device is a valid option for initial treatment of post-OLTX biliary stricture.

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Endoscopic Management of Post–Liver Transplantation Biliary Strictures With the Use of Fully Covered Metallic Stents

Cited by 12 publications

References 23 publications

Migration rate using fully covered metal stent in anastomotic strictures after liver transplantation: Results from the BASALT study group

Migration rate using fully covered metal stent in anastomotic strictures after liver transplantation: Results from the BASALT study group

Endoscopic treatment of anastomotic biliary stricture after adult deceased donor liver transplantation with multiple plastic stents versus self-expandable metal stents: a systematic review and meta-analysis

Metallic vs plastic stents to treat biliary stricture after liver transplantation: a systematic review and meta-analysis based on randomized trials

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