Optimal drainage of anastomosis stricture after living donor liver transplantation

Sung, Min Je; Jo, Jung Hyun; Lee, Hee-Seung; Park, Jeong Youp; Bang, Seungmin; Park, Seung Woo; Song, Si Young; Joo, Dong Jin; Chung, Moon Jae

doi:10.1007/s00464-021-08456-4

Cited by 3 publications

(3 citation statements)

References 46 publications

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“…Table 1 summarizes the main characteristics of the included studies. Five studies were retrospective [ 22 , 24 , 25 , 27 , 29 ], 3 RCTs [ 26 , 28 , 30 ], and the remaining 1 was a non-randomized prospective study [ 23 ], Three studies compared ID-SEMS with MPS [ 23 , 24 , 30 ] and 5 FC-SEMS with MPS [ 25 - 29 ], whereas 1 included all 3 approaches [ 22 ].…”

Section: Resultsmentioning

confidence: 99%

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Efficacy of different stent types in post-liver-transplant anastomotic biliary strictures: a systematic review and meta-analysis

Papaefthymiou

2024

aog

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Background Stent selection in the endoscopic management of post-liver-transplant anastomotic biliary strictures remains controversial. This systematic review and meta-analysis aimed to evaluate the potential differences between available stents. Methods MEDLINE, Cochrane, and Scopus databases were searched until April 2023 for comparative studies evaluating stricture management using multiple plastic stents (MPS) and self-expandable metal stents (SEMS), including fully-covered (FC)- and intraductal (ID)-SEMS. The primary outcome was stricture resolution, while secondary outcomes included stricture recurrence, stent migration and adverse events. Meta-analyses were based on a random-effects model and the results were reported as odds ratios (OR) with 95% confidence intervals (CI). Subgroup analyses by type of metal stent and a cost-effectiveness analysis were also performed. Results Nine studies (687 patients) were finally included. Considering stricture resolution, SEMS and MPS did not differ significantly (OR 0.99, 95%CI 0.48-2.01; I 2 =35%). Stricture recurrence, migration rates and adverse events were also comparable (OR 1.71, 95%CI 0.87-3.38; I 2 =55%, OR 0.73, 95%CI 0.32-1.68; I 2 =56%, and OR 1.47, 95%CI 0.89-2.43; I 2 =24%, respectively). In the subgroup analysis, stricture resolution and recurrence rates did not differ for ID-SEMS vs. MPS or FC-SEMS vs. MPS. Migration rates were lower for ID-SEMS compared to MPS (OR 0.28, 95%CI 0.11-0.70; I 2 =0%), and complication rates were higher after FC-SEMS compared to MPS (OR 1.76, 95%CI 1.06-2.93; I 2 =0%). Finally, ID-SEMS were the most cost-effective approach, with the lowest incremental cost-effectiveness ratio: 3447.6 £/QALY. Conclusion Stent type did not affect stricture resolution and recurrence; however, ID-SEMS placement was the most cost-effective approach compared to the alternatives.

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Section: Resultsmentioning

confidence: 99%

“…SEMS were placed in 251 patients, including 82 with ID-SEMS and 169 with FC-SEMS, and MPS in 436 cases. Stent diameter for ID-SEMS was 8-10 mm, except for 1 study where 6-8-mm stents were inserted [ 23 ]. Two studies provided detailed information about FC-SEMS and both used 8-10-mm diameter stents [ 28 , 29 ].…”

Section: Resultsmentioning

confidence: 99%

Efficacy of different stent types in post-liver-transplant anastomotic biliary strictures: a systematic review and meta-analysis

Papaefthymiou

2024

aog

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“…Percutaneous and surgical drainage are general managements, endoscopic interventions also have been reported to have successful outcomes in children [5] . Endoscopic biliary stenting (EBS) drainage with FC-SEMSs or plastic stent (PS) has been reported potentially e cient for ABS after liver transplantation in adults [4] . Although Endoscopy has replaced surgery in most patients with ABS, approximately 10%~20% of patients require surgical revision in the long run [9] .…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Endoscopic Retrograde Cholangiopancreatography for Pediatric Hepato-Pancreato-Biliary diseases: A Systematic Review and Meta-analysis

Sun

Zheng

et al. 2022

Preprint

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Background: Hepato-pancreato-biliary (HPB) disease has different causes and types between children and adults, which have been diagnosed increasingly in the pediatric group. Endoscopic retrograde cholangiopancreatography (ERCP) has been gradually considered as a therapeutic method in adults, while in pediatric patients, there are not many reports of its usage. This systematic review and meta-analysis aims to assess the use condition of therapeutic ERCP in the management of pediatric HPB diseases.Methods: This systematic literature search was conducted in the PubMed、Embase、Web of Science and the Cochrane library databases to identify all relevant articles published from inception to February 2022 that evaluated therapeutic ERCP in pediatric patients with Hepato-Pancreato-Biliary diseases. The researchers included studies that patients were less than 18 years old and underwent therapeutic ERCP procedures. A random-effects model was used to analyze the usage rate of therapeutic ERCP-procedures, procedural success rates, adverse events rates, and the rate of different therapeutic procedures. Subgroup analysis, sensitivity analysis, and meta-regression were conducted to analyze the source of heterogeneity.Results: A total of 33 articles were included. After homogenization, the overall usage of therapeutic interventions accounts for 77% (95%CI74%-81%) in all ERCP procedures. After excluding outlier studies, the estimation of therapeutic procedure success rate is 74% (95% CI 69 %-79%), adverse events rate is 8% ( 95% CI 6 %-10%). In our study, stent placement is the most common procedure which makes up 75% (95%CI 65%-86%) of all therapeutic procedures. In addition, the usage proportion of sphincterotomy (ST), stone extraction/removal, bougienage/Balloon dilation is respectively 46% (95% CI 39 %-53%), 34% (95% CI 31%-38%), and 26% (95% CI 22%-29%).Conclusions: ERCP procedure is gradually considered as a therapeutic technique in pediatric patients, the proportion of therapeutic ERCP is 77% of total usage, which is increasing by the year. Meanwhile, its success rate is relatively high. It reflects that this operation modality is promising in the treatment of Hepato-pancreato-biliary disorders and is gradually expanded as more branch technologies are being used. A variety of operations can be achieved through ERCP procedures, and more functions should be developed in the future.

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Role of ERCP in Benign Biliary Strictures

Schepis

Boškoski

Tringali

et al. 2022

Gastrointestinal Endoscopy Clinics of North America

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Optimal drainage of anastomosis stricture after living donor liver transplantation

Cited by 3 publications

References 46 publications

Efficacy of different stent types in post-liver-transplant anastomotic biliary strictures: a systematic review and meta-analysis

Efficacy of different stent types in post-liver-transplant anastomotic biliary strictures: a systematic review and meta-analysis

Therapeutic Endoscopic Retrograde Cholangiopancreatography for Pediatric Hepato-Pancreato-Biliary diseases: A Systematic Review and Meta-analysis

Role of ERCP in Benign Biliary Strictures

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