To stent or not to stent: the use of transanastomotic biliary stents in liver transplantation and patient outcomes

Ong, Michelle; Slater, Kellee; Hodgkinson, Peter; Dunn, Nathan; Fawcett, Jonathan

doi:10.1111/ans.14383

Cited by 7 publications

(6 citation statements)

References 15 publications

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“…1 ), 1469 articles were detected using the following search string: liver transplantation, stent, and biliary complications. According to our eligibility criteria and after careful selection, 17 studies 8 , 10 – 25 with total of 2623 patients were included in the meta-analysis. These trials included 13 retrospective cohort studies 8 , 10 , 11 , 13 – 21 , 24 , 25 and 4 randomized controlled trials.…”

Section: Resultsmentioning

confidence: 99%

“…According to our eligibility criteria and after careful selection, 17 studies 8 , 10 – 25 with total of 2623 patients were included in the meta-analysis. These trials included 13 retrospective cohort studies 8 , 10 , 11 , 13 – 21 , 24 , 25 and 4 randomized controlled trials. 12 ,] 21 – 23 All of them were single center studies.…”

Section: Resultsmentioning

confidence: 99%

“…5 , 6 On the other hand, other studies found that trans-anastomotic biliary stent was not required in liver transplantation to decrease the incidence of biliary complications and biliary reconstruction without stenting was a safe and efficient technique. 7 , 8 In addition to that, as reported by some studies, the routine use of endobiliary stents is associated with a remarkable increase in the biliary complications and increases the rate of biliary intervention. This study aimed to compare the rate of biliary complication with and without the use of trans anastomotic biliary stent (internal and external) in liver transplantation.…”

mentioning

confidence: 94%

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Do We Need to Use a Stent in Biliary Reconstruction to Decrease the Incidence of Biliary Complications in Liver Transplantation? A Systematic Review and Meta-Analysis

Elkomos

Abdelaal

2023

Journal of Gastrointestinal Surgery

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Background and Aim Biliary complications are a significant cause of morbidity post-transplantation, and the routine use of biliary stents in liver transplantation to reduce these complications remains controversial. This study aimed to compare the incidence of biliary complications with and without the use of trans anastomotic biliary stent in liver transplantation. Method PubMed, Scopes, Web of Science, and Cochrane library were searched for eligible studies from inception to February 2022, and a systematic review and meta-analysis were done to compare the incidence of biliary complications in the two groups. Results Seventeen studies with a total of 2623 patients were included. The pooled results from the included studies showed an equal rate of biliary complications (i.e., strictures, leaks and cholangitis) in stented and non-stented patients after liver transplantation. However, the cost and biliary intervention rates are higher in stented patients. In addition to that, our sub-group analysis showed no significant decrease in the incidence of biliary complications after using trans anastomotic biliary stent in living donor liver transplant (LDLT), deceased donor liver transplant (DDLT), Roux-en-Y hepaticojejunostomy (RYHJ), and duct-to-duct anastomosis, pediatric, and adult liver transplantation. Conclusion No added benefit on the routine use of endobiliary stent in liver transplantation. However, stented patients are at higher risk of needing multiple ERCPs.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 94%

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Do We Need to Use a Stent in Biliary Reconstruction to Decrease the Incidence of Biliary Complications in Liver Transplantation? A Systematic Review and Meta-Analysis

Elkomos

Abdelaal

2023

Journal of Gastrointestinal Surgery

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“…The authors emphasize diligent preoperative assessment of donor bile ducts, meticulous surgical technique, and avoiding transanastomotic stenting in LDLT. Similarly, Ong et al [57] found limited benefit to transanastomotic biliary stents in adult recipients of deceased donor liver transplantation, noting a 3-times more likely need for subsequent intervention. In conclusion, biliary complications are a major source of morbidity after both living and deceased donor liver transplantation.…”

Section: Bile Ductmentioning

confidence: 99%

The devil is in the detail: current management of perioperative surgical complications after liver transplantation

Patel

DiNorcia²

2019

Current Opinion in Organ Transplantation

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Purpose of reviewDespite advances in the field, perioperative morbidity is common after liver transplantation. This review examines the current literature to provide up-to-date management of common surgical complications associated with liver transplantation. Recent findingsResearch focuses on problems with anastomoses of the vena cava, portal vein, hepatic artery, and bile ducts. Interventional endoscopic and radiological techniques are used more frequently to avoid reoperation.

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“…The randomized study by Scatton et al indicated a 1.11% incidence of T-tube-related anastomotic strictures in the T-tube group compared to an incidence of 4.44% in the non-T-tube group [14]. The retrospective observational study by Ong et al revealed a 12.6% incidence of anastomotic strictures after the use of a Ttube compared to 5.3% in patients without a T-tube [15]. In addition, an anastomotic leak was recorded in 2.3% of patients with a T-tube compared to 2.6% in patients without a T-tube.…”

Section: Bile Leaks and Stricturesmentioning

confidence: 99%

Biliary Anastomosis Using T-tube Versus No T-tube for Liver Transplantation in Adults: A Review of Literature

Vest¹,

Ciobanu²,

Nyabera³

et al. 2022

Cureus

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The T-tube-directed biliary anastomosis in orthotopic liver transplantation (OLT) aims to minimize preventable biliary complications, including bile leaks and strictures. Biliary complications in patients with OLT increase the risk of morbidity and mortality. This review paper evaluated the current evidence on the routine use of T-tube reconstruction in OLT cases.A review of prospective, retrospective, observational, cohort studies as well as systematic reviews, metaanalyses, review papers, and opinion papers has been conducted to evaluate the therapeutic potential of T tube-based biliary anastomosis in cases of OLT.Our finding showed a bile leak incidence of 16.6% and 6.6% in T-tube and non-T-tube groups, respectively. The results indicated a lower incidence of anastomotic fistulae in the non-T-tube group (0.6%) compared to the T-tube group (4%). The findings negated statistically significant differences in the three-year actuarial survival rates based on biliary anastomosis with and without T-tube intervention (62.5% vs. 69.8%). The studies revealed a 6-11% and 2-11% incidence of cholangitis in OLT patients with T-tube-based reconstruction and those without a T-tube, respectively, and 26% and 20% incidence of total biliary complications in OLT patients with and without T-tube, respectively. In addition, the findings ruled out the influence of a T-tube on the incidence of perioperative complications, endoscopies, and reoperations in OLT cases.The current evidence correlates the increased incidence of bile leaks, cholangitis, and overall biliary complications with the use of a T-tube during OLT. In addition, T-tube-guided reconstruction has no impact on perioperative complications, overall survival, endoscopies, and reoperations in OLT cases.

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To stent or not to stent: the use of transanastomotic biliary stents in liver transplantation and patient outcomes

Abstract: These results suggest that there is limited benefit in the placement of endobiliary stents in liver transplantation. Given that this was purely an observational study, causality cannot be proven and a prospective cohort trial would be beneficial in further defining these relationships.

Cited by 7 publications

References 15 publications

Do We Need to Use a Stent in Biliary Reconstruction to Decrease the Incidence of Biliary Complications in Liver Transplantation? A Systematic Review and Meta-Analysis

Do We Need to Use a Stent in Biliary Reconstruction to Decrease the Incidence of Biliary Complications in Liver Transplantation? A Systematic Review and Meta-Analysis

The devil is in the detail: current management of perioperative surgical complications after liver transplantation

Biliary Anastomosis Using T-tube Versus No T-tube for Liver Transplantation in Adults: A Review of Literature

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