Multiple plastic stents versus covered metal stent for treatment of anastomotic biliary strictures after liver transplantation: a prospective, randomized, multicenter trial

Tal, Andrea O.; Finkelmeier, Fabian; Filmann, Natalie; Kylänpää, Leena; Udd, Marianne; Parzanese, I.; Cantù, P.; Dechêne, Alexander; Penndorf, Volker; Schnitzbauer, Andreas A.; Friedrich‐Rust, Mireen; Zeuzem, Stefan; Albert, Jörg G.

doi:10.1016/j.gie.2017.03.009

Cited by 81 publications

(101 citation statements)

References 20 publications

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“…Because they are readily removed from the bile duct during ERCP [90], covered SEMS are more appropriate for benign biliary strictures. In two recent RCTs of covered SESM versus multiple PSs for biliary strictures after DDLT, stricture resolution rates were similar, but covered SEMS required significantly fewer ERCPs to resolve the strictures [91,92].…”

Section: Self-expandable Metallic Sent Placementmentioning

confidence: 99%

“…A German RCT demonstrated a 33% incidence of covered SEMS migration in post-DDLT strictures [91]. According to a recent systematic review by Kao et al, the overall SEMS migration rate was 16% [94].…”

Section: Self-expandable Metallic Sent Placementmentioning

confidence: 99%

“…Other factors likely to be associated with stent migration include a stricture close to the hilum, a large bile duct below the stricture, and a short stricture [95]. While stent migration occurred spontaneously without the need for further interventions in some cases [91], it could result in severe consequences [95]. Stent migration might have a negative impact on stricture resolution [96].…”

Section: Self-expandable Metallic Sent Placementmentioning

confidence: 99%

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Endoscopic management of biliary strictures after living donor liver transplantation

Tsujino

Isayama

Kogure

et al. 2017

Clin J Gastroenterol

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Living donor liver transplantation (LDLT) is an effective alternative to deceased liver transplantation (DDLT) for end-stage liver disease. Although advances in surgical techniques, immunosuppressive management, and post-transplant care have improved the overall outcomes of LDLT, biliary strictures remain the major unsolved problem. Endoscopic retrograde cholangiopancreatography (ERCP) is currently considered the first-line therapy for biliary strictures following LDLT with duct-to-duct reconstruction, with percutaneous and surgical interventions reserved for patients with unsuccessful management via ERCP. Endoscopic management of biliary strictures is technically more challenging in LDLT than in DDLT because of the complexity of the biliary anastomosis, in addition to the tortuous and angulated biliary system. Placement of one or more plastic stents after balloon dilation has been the standard strategy for post-LDLT stricture, but this requires multiple stent exchange to prevent stent occlusion until stricture resolution. Inside stents might prevent duodenobiliary reflux and thus have longer stent patency, obviating the need for multiple ERCPs. Newly developed covered self-expandable metallic stents with anti-migration systems are alternatives to the placement of multiple plastic stents. With the advent of deep enteroscopy, biliary strictures in LDLT patients with Rouxen-Y hepaticojejunostomy are now treatable endoscopically. In this review, we discuss the short-and long-term outcomes of endoscopic management of post-LDLT strictures as well as recent advances in this field.

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Section: Self-expandable Metallic Sent Placementmentioning

confidence: 99%

Section: Self-expandable Metallic Sent Placementmentioning

confidence: 99%

Section: Self-expandable Metallic Sent Placementmentioning

confidence: 99%

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Endoscopic management of biliary strictures after living donor liver transplantation

Tsujino

Isayama

Kogure

et al. 2017

Clin J Gastroenterol

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“…Up to now, 4 randomized controlled trials comparing the multistenting technique with SEMS placement have been published (Table ) . Overall, the 4 studies included 200 patients randomized to one or the other treatment modality.…”

Section: Endoscopic Management Of Biliary Stricturesmentioning

confidence: 99%

Endoscopic Management of Benign Biliary Strictures After Liver Transplantation

et al. 2019

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Biliary strictures represent some of the most frequent complications encountered after orthotopic liver transplantation. They comprise an array of biliary abnormalities with variations in anatomical location, clinical presentation, and different pathogenesis. Magnetic resonance cholangiography represents the most accurate noninvasive imaging test that can provide detailed imaging of the whole biliary system—below and above the anastomosis. It is of particular value in those harboring complex hilar or intrahepatic strictures, offering a detailed roadmap for planning therapeutic procedures. Endoscopic therapy of biliary strictures usually requires biliary sphincterotomy plus balloon dilation and stent placement. However, endoscopic management of nonanastomotic biliary strictures is much more complex and challenging as compared with anastomotic biliary strictures. The present article is a narrative review presenting the results of endoscopic treatment of biliary strictures occurring after liver transplantation, describing the different strategies based on the nature of the stricture and summarizing their outcomes.

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“…Despite these advantages, the initial use of SEMS over multiple plastic stents for ABS after LT does not appear to be supported so far. Based on four randomized controlled trials and meta‐analysis, rates of complication, stent migration, and stricture recurrence were significantly higher in SEMS groups than those in plastic stent groups . In this regard, SEMS can be reserved for unsuccessful cases of plastic stent placement.…”

Section: Discussionmentioning

confidence: 99%

Intraductal placement of non‐flared fully covered metallic stent for refractory anastomotic biliary strictures after living donor liver transplantation: Long‐term results of prospective multicenter trial

Yoo

Lee

et al. 2019

J of Gastro and Hepatol

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Background and Aim Fully covered self‐expandable metallic stent (FCSEMS) may be an effective modality for managing anastomotic biliary stricture (ABS) after liver transplantation. However, stent migration and stent‐induced ductal injury are the main limitations. The objective of this study was to evaluate the usefulness of an unflared, intraductal FCSEMS that was designed to minimize migration and ductal injury for refractory ABS after living donor liver transplantation (LDLT). Methods A total of 32 consecutive patients with symptomatic ABS after LDLT unresolved by plastic stents with or without balloon dilation at four tertiary medical centers were prospectively enrolled. A short (3 or 5 cm) FCSEMS having long lasso (10 cm) used in this study had unflared convex ends to minimize tissue hyperplasia and smaller center portion to prevent migration. The FCSEMS was placed above the papilla and removed at 3–4 months after stenting. Results Technical and clinical success rates of intraductal placement with FCSEMS were 100% (32/32) and 81.2% (26/32), respectively. Early stent migration was observed in five (15.6%) patients. However, three patients with early stent migration had stricture resolution without needing additional intervention. Intended stent removal was successful in 27 (100%) patients (median, 101 days; range, 23–118 days). No stent‐induced ductal change was observed in all patients. Stricture recurrence was observed in 11.5% (3/26) of patients during 639 days of median duration of follow‐up (range, 366–2079 days). Conclusions Intraductal placement of an unflared short FCSEMS may be a promising option for refractory ABS after LDLT with minimal stent‐induced ductal injury and stent migration.

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Multiple plastic stents versus covered metal stent for treatment of anastomotic biliary strictures after liver transplantation: a prospective, randomized, multicenter trial

Abstract: cSEMSs for treatment of ABSs needed less endoscopic interventions to achieve similar efficacy as MPS and might become a new treatment standard. However, the optimal duration of cSEMS therapy and cost-efficacy have to be evaluated. (Clinical trial registration number: NCT01393067.).

Cited by 81 publications

References 20 publications

Endoscopic management of biliary strictures after living donor liver transplantation

Endoscopic management of biliary strictures after living donor liver transplantation

Endoscopic Management of Benign Biliary Strictures After Liver Transplantation

Intraductal placement of non‐flared fully covered metallic stent for refractory anastomotic biliary strictures after living donor liver transplantation: Long‐term results of prospective multicenter trial

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