Management of biliary anastomotic strictures after liver transplantation (BASALT study): A nationwide Italian survey

Cantù, P.; Parzanese, I.; Sario, A. Di; Soggiu, Fiammetta; Lombardi, G; Barbaro, Federico; Pisani, Antonio; Baldan, Anna; Cariani, Giulio; Boarino, V.; Fasoli, Alberto; Bertani, Helga; Forti, Edoardo; Bulajić, Milutin; Ghinolfi, Davide; Nadal, E.; Cerofolini, Angelo; Barresi, Luca; Catalano, Giorgia; Stroppa, I.; Traini, Sara; Mazzaferro, Vincenzo; Cipolletta, Livio; Tringali, Andrea; Costamagna, Guido; Ravelli, P.; Bazzoli, Franco; Merighi, A.; Parodi, M.C.; Conigliaro, Rita; Mutignani, Massimiliano; Zilli, M.; Filipponi, Franco; Fantin, Alberto; Rodella, Luca; Tarantino, Ilaria; Traina, Mario; Salizzoni, Mauro; Rosa, Roberto; Malinverno, Federica; Invernizzi, Federica; Manini, M.A.; Donato, Maria Francesca; Colombo, Massimo; Conte, Dario; Rossi, G.; Penagini, Roberto

doi:10.1002/lt.24701

Cited by 18 publications

(25 citation statements)

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“…This type of treatment requires three to five endoscopic procedures a year and thus impacts into associated costs, which includes the costs of stents, ERCPs, devices other than stents, human resources, and repeated hospitalizations. Fully covered metal stents, initially designed for palliation of malignant strictures, have been tested and approved for the treatment of benign strictures [6–14]. The large diameter of metal stents can achieve a sudden maximal dilation and shorten the duration of treatment as only two procedures (for insertion and removal) are required, thus reducing costs.…”

Section: Discussionmentioning

confidence: 99%

“…Several authors have reported optimal results with the traditional multi‐stenting technique [3–5], which consists of progressive dilation of the stricture by increasing the number of plastic stents placed side‐by‐side in multiple procedures. This is the most common option in everyday practice [6]. Recently, fully covered self‐expandable metal stents (FCSEMS) have been designed for easy removal in benign biliary strictures [7–14].…”

Section: Introductionmentioning

confidence: 99%

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Cost analysis of a long‐term randomized controlled study in biliary duct‐to‐duct anastomotic stricture after liver transplantation

et al. 2021

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Multiple plastic stent (MPS) for biliary anastomotic stricture (AS) after liver transplantation requires multiple procedures with consequent costs. To compare the success, adverse events and treatment-related costs of fully covered self-expandable metal stents (FCSEMS) versus MPS. Thirty liver transplant (LT) patients with clinically relevant na€ ıve AS were prospectively randomized to FCSEMS or MPS, with stent numbers increased at 3-month intervals. Treatment costs per patient were calculated for endoscopic retrograde cholangiopancreatography (including all devices and stents) and overall hospital stay. Radiological success was achieved in 73% of FCSEMS (median indwelling period of 6 mos) and 93% of MPS patients (P = NS) (median period of 11 mos). AS recurrence occurred in 36% of FCSEMS and 7% of MPS patients (P = NS), and AS re-treatment was needed in 53% and 13% (P < 0.01), respectively, during follow-up of 60 (34-80) months. Stents migrated after 29% and 2.6% of FCSEMS and MPS procedures, respectively (P < 0.01). Including re-treatments, long-term clinical success was achieved in 28/30 (93%) patients. Overall treatment-related costs were similar between groups. In the subgroup of LT patients in clinical remission after first-line treatment, treatment costs were 41% lower per FCSEMS patient compared with MPS patients. FCSEMS did not perform better than MPS. FCSEMS migration increased the rate of re-treatment and costs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cost analysis of a long‐term randomized controlled study in biliary duct‐to‐duct anastomotic stricture after liver transplantation

et al. 2021

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“…Cholestasis, abnormal liver function tests (LFT), and jaundice are the main manifestations 9 . To date, different radiological techniques are available in the diagnostic process, including magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasonography (EUS) 9,22 . Transhepatic cholangiography is an alternative although limited by a non‐dilated intrahepatic biliary tree in most patients and by the availability of an expert interventional radiologist 23 …”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of device‐assisted enteroscopy ERCP in liver transplantation: A systematic review and meta‐analysis

Ferretti

Fraquelli

Cantù

et al. 2020

Clinical Transplantation

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Background Enterobiliary anastomoses are the main source of complications after liver transplantation. An endoscopic approach combining device‐assisted enteroscopy and ERCP (DAE‐ERCP) is technically feasible in postsurgical anatomy. Aims This study aimed at assessing the efficacy, feasibility, and safety of DAE‐ERCP in liver‐transplanted patients (LT) and other subsets (non‐LT). Methods A systematic review and meta‐analysis of studies involving DAE procedures in LT patients (between January 2000 and May 2017) was conducted. The main endpoints were as follows: endoscopic, diagnostic, therapeutic, and overall success rates, complications, and the need for surgery. Results A total of 155 studies were retrieved, and 6 relevant trials were analyzed. Overall, 132 subjects (72 LT and 60 non‐LT) undergoing 257 DAE‐ERCP (135 and 122) were included. Complications were rare (4/257), and no deaths occurred. These are the pooled success rates among LT and non‐LT patients: 80%‐100% and 82%‐95% (enteroscopic), 75%‐100% and 89%‐100% (diagnostic), 67%‐100% and 92%‐100% (therapeutic), and 60%‐100% and 79%‐83% (overall results). The requirement for surgery was similar in the two subgroups. Conclusion In managing biliary complications, the high diagnostic and therapeutic success rates of DAE‐ERCP combined with its safety and feasibility encourage its application as a first‐line approach to transplanted patients.

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“…All the participants signed the informed consent form. The selection criteria for anastomotic stricture were homogenous among all centres, as recently assessed by a national survey among the same endoscopic units (BASALT study group) working with the Italian Liver Transplantation Centers, LT patients were considered for anastomotic stricture treatments in case of any alteration of liver tests persisting within 3 months and magnetic resonance or Kehr cholangiography being consistent with anastomotic stricture. Severity of the stricture was defined according to international criteria.…”

Section: Methodsmentioning

confidence: 99%

Endo‐therapies for biliary duct‐to‐duct anastomotic stricture after liver transplantation: Outcomes of a nationwide survey

Cantù

Tarantino

Baldan

et al. 2019

Liver International

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Abbreviations: ERCP, endoscopic retrograde cholangiopancreatography; IQR, inter quartile range; LT, liver transplanted; PEP, post-ERCP pancreatitis; SEMS, self-expandable metal stent. AbstractBackground: The most appropriate endo-therapeutic approach to biliary anastomotic strictures is yet to be defined. Aim:To retrospectively report on the endo-therapy of duct-to-duct anastomotic strictures during 2013 in Italy.Methods: Data were collected from 16 Endoscopy Units at the Italian Liver Transplantation Centers (BASALT study group).Results: Complete endo-therapy and follow-up data are available for 181 patients: 101 treated with plastic multistenting, 26 with fully covered self-expandable metal stenting and 54 with single stenting. Radiological success was achieved for 145 patients (80%), that is, 88% of plastic multistenting, 88% of self-expandable metal stenting and 61% of single stenting (P < 0.001 vs plastic multistenting; P < 0.05 vs self-expandable metal stenting). After first-line endo-therapy failure, the patients underwent a second-line endo-therapy with plastic multistenting for 25%, fully covered self-expandable metal stenting for 53% and single stenting for 22% of cases, and radiological success was achieved for 84%, that is, 100%, 85% and 63% with plastic multistenting, self-expandable metal stenting and single stenting (P < 0.05 vs plastic multistenting or self-expandable metal stenting) respectively. Procedure-related complications occurred in 7.8% of endoscopic retrograde cholangiopancreatographies. Overall, clinical success was achieved in 87% of patients after a median followup of 25 months. Conclusion:Plastic multistenting is confirmed as the preferred first-line treatment, while fully covered self-expandable metal stenting as rescue option for biliary anastomotic strictures. Single stenting has sub-optimal results and should be abandoned. K E Y W O R D S biliary anastomotic stricture, ERCP, fully covered metal stenting, liver transplantation, plastic multistenting How to cite this article: Cantù P, Tarantino I, Baldan A, et al. Endo-therapies for biliary duct-to-duct anastomotic stricture after liver transplantation: Outcomes of a nationwide survey.

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Management of biliary anastomotic strictures after liver transplantation (BASALT study): A nationwide Italian survey

Cited by 18 publications

References 5 publications

Cost analysis of a long‐term randomized controlled study in biliary duct‐to‐duct anastomotic stricture after liver transplantation

Cost analysis of a long‐term randomized controlled study in biliary duct‐to‐duct anastomotic stricture after liver transplantation

Efficacy and safety of device‐assisted enteroscopy ERCP in liver transplantation: A systematic review and meta‐analysis

Endo‐therapies for biliary duct‐to‐duct anastomotic stricture after liver transplantation: Outcomes of a nationwide survey

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