Managing the post–liver transplantation anastomotic biliary stricture: multiple plastic versus metal stents: a systematic review

Kao, Dina; Zepeda-Gómez, Sergio; Tandon, Puneeta; Bain, Vincent G.

doi:10.1016/j.gie.2013.01.015

Cited by 127 publications

(118 citation statements)

References 58 publications

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“…Multiple sessions of balloon dilation followed by the endoscopic placement of plastic stents is the most commonly adopted strategy for the treatment of ABS after OLT (5) . The present systematic review makes clear that there is a paucity of well-designed randomized controlled trials to support this strategy.…”

Section: Discussionmentioning

confidence: 99%

“…The first series employed partially covered stents which presented lower migration rates at the cost of embedding of the uncovered mesh into the duct wall making its removal difficult and causing irreversible inflammatory changes in the bile duct (5) . More recently fully covered metallic stents were employed with higher migration rates and variable results (5) . We found a systematic review comparing the use of multiple plastic stents with self-expandable metallic stents for the treatment of ABS after OLT (5) .…”

Section: Discussionmentioning

confidence: 99%

“…More recently fully covered metallic stents were employed with higher migration rates and variable results (5) . We found a systematic review comparing the use of multiple plastic stents with self-expandable metallic stents for the treatment of ABS after OLT (5) . The authors recognize that there were no well-designed randomized trials, but only small case series for both treatment strategies, making impossible a meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Biliary fistula, anastomotic biliary strictures (ABS) (5,17) and ischemic biliary lesions (18) figure among the most common complications after OLT.…”

Section: Introductionmentioning

confidence: 99%

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ENDOSCOPIC TREATMENT OF POST-LIVER TRANSPLANTATION ANASTOMOTIC BILIARY STRICTURE: systematic review andmeta-analysis

Nacif¹,

Bernardo

et al. 2014

Arq. Gastroenterol.

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-Context -Biliary strictures after liver transplantation are recognized as its Achilles' heel. The strictures are classified in anastomotic and ischemic or non-anastomotic biliary strictures, and they figure among the most common complications after liver transplantation. There are some treatment options including balloon dilation, the placement of multiple plastic stents and the placement of self-expandable metal stents and all of them seem to have good results. Objective -The aim of this study was to systematically review the literature concerning the results of the endoscopic treatment of anastomotic biliary strictures after liver transplantation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Biliary fistula, anastomotic biliary strictures (ABS) (5,17) and ischemic biliary lesions (18) figure among the most common complications after OLT.…”

Section: Introductionmentioning

confidence: 99%

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ENDOSCOPIC TREATMENT OF POST-LIVER TRANSPLANTATION ANASTOMOTIC BILIARY STRICTURE: systematic review andmeta-analysis

Nacif¹,

Bernardo

et al. 2014

Arq. Gastroenterol.

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“…No controlled prospective studies have compared the effectiveness of multiple PS with FCSEMS. There is no definitive evidence supporting the hypothesis that FCSEMS is superior to PS for patients with anastomotic strictures following LT [11,12]. Since FCS-EMS placement can be performed in one step, it is logical to first place a PS for their early efficacy, followed by FCS-EMS for more durable results.…”

mentioning

confidence: 99%

Covered Self-Expandable Metal Stents for the Treatment of Benign Biliary Strictures After Liver Transplantation: When and How?

Lee

2013

Dig Dis Sci

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Benign biliary strictures (BBS) may complicate biliary surgery including liver transplantation (LT) [1]. The firstline management of BBS, including anastomotic strictures after LT, now incorporates endoscopic therapy, mostly consisting of stenting [2]. Although originally designed for endoscopic palliation of malignant biliary strictures, the self-expandable metallic stent (SEMS) is a valid alternative to surgery for BBS. Patients with malignant biliary strictures who undergo treatment with metal stents have a limited life expectancy due to the poor prognosis of the underlying disease. Therefore, for patients with BBS who have a normal life expectancy, the indications for metal stent placement should differ from those applied to malignant biliary strictures.Metal stents can be divided into uncovered SEMS, partially covered SEMS, and fully covered SEMS (FCS-EMS). Non-removable uncovered SEMS cannot be used for BBS due to their limited patency, since reactive hyperplastic tissue may extend through the metal mesh. Partially covered SEMS can be used for BBS to decrease the rate of stent migration; however, the uncovered portion can embed in the bile duct wall. FCSEMS are a good first choice because of their easy removal and long duration of patency due to lack of tissue hyperplasia and implantation into the biliary tree. Since frequent spontaneous stent migration is a major adverse event associated with FCS-EMS, an anchoring system such as flared ends or anchoring fins has been developed [3].In this issue of Digestive Diseases and Sciences, Kahaleh's group reports the retrospectively analyzed outcomes of covered SEMS for 55 patients with anastomotic strictures after LT [4]. Twenty-seven of 55 (49.1 %) patients were treated with plastic stents prior to covered SEMS. The authors applied three different types of covered SEMS: partially covered SEMS (19 patients), FCSEMS with anchoring fins (21 patients), and FCSEMS with flared ends (15 patients). Endoscopic biliary sphincterotomy was performed in all patients. Although the authors endeavored to center the stent within the stricture, success was not universal. All covered SEMS were removed after 3-4 months. The technical success rate was 100 %, but the clinical success rate, as measured by stricture resolution, was unsatisfactory (60-74 %). Even after covered SEMS placement, three (5.5 %) patients eventually required surgery to resolve their biliary strictures. Notably, the stentrelated adverse event rate involving migration and occlusion was 7-24 %. Five patients with early stent occlusion required repeat stenting. Indeed, the clinical success rate of endoscopic stenting with multiple plastic stents is reportedly 87-94 % [5].The location of the stricture is usually the most proximal aspect of the common hepatic duct in anastomotic strictures after LT, especially after living-related LT recipients, in whom the strictured segment is usually short. To achieve effective stenting with covered SEMS, the stent should be centered within the strictured bile duct segment, which ...

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Effect of Covered Metallic Stents Compared With Plastic Stents on Benign Biliary Stricture Resolution

Coté

Slivka

Tarnasky

et al. 2016

JAMA

211

193

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Managing the post–liver transplantation anastomotic biliary stricture: multiple plastic versus metal stents: a systematic review

Cited by 127 publications

References 58 publications

ENDOSCOPIC TREATMENT OF POST-LIVER TRANSPLANTATION ANASTOMOTIC BILIARY STRICTURE: systematic review andmeta-analysis

ENDOSCOPIC TREATMENT OF POST-LIVER TRANSPLANTATION ANASTOMOTIC BILIARY STRICTURE: systematic review andmeta-analysis

Covered Self-Expandable Metal Stents for the Treatment of Benign Biliary Strictures After Liver Transplantation: When and How?

Effect of Covered Metallic Stents Compared With Plastic Stents on Benign Biliary Stricture Resolution

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