Intraductal fully covered self-expanding metal stents in the management of post-liver transplant anastomotic strictures: a UK wide experience

Autor: Wafaa Ahmed, Dave Kyle, Amardeep Khanna, John Devlin, David Reffitt, Zeino Zeino, George Webster, Simon Phillpotts, Robert Gordon, Gareth Corbett, William Gelson, Manu Nayar, Haider Khan, Matthew Cramp, Jonathan Potts, Waleed Fateen, Hamish Miller, Bharat Paranandi, Matthew Huggett, Simon M. Everett, Vinod S. Hegade, Rebecca O’Kane, Ryan Scott, Neil McDougall, Phillip Harrison, Deepak Joshi
Jazyk: angličtina
Rok vydání: 2022
Předmět:
Zdroj: Therapeutic Advances in Gastroenterology, Vol 15 (2022)
Druh dokumentu: article
ISSN: 1756-2848
17562848
DOI: 10.1177/17562848221122473
Popis: Background: Fully covered intraductal self-expanding metal stents (IDSEMS) have been well described in the management of post-liver transplant (LT) anastomotic strictures (ASs). Their antimigration waists and intraductal nature make them suited for deployment across the biliary anastomosis. Objectives: We conducted a multicentre study to analyse their use and efficacy in the management of AS. Design: This was a retrospective, multicentre observational study across nine tertiary centres in the United Kingdom. Methods: Consecutive patients who underwent endoscopic retrograde cholangiopancreatography with IDSEMS insertion were analysed retrospectively. Recorded variables included patient demographics, procedural characteristics, response to therapy and follow-up data. Results: In all, 162 patients (100 males, 62%) underwent 176 episodes of IDSEMS insertion for AS. Aetiology of liver disease in this cohort included hepatocellular carcinoma ( n = 35, 22%), followed by alcohol-related liver disease ( n = 29, 18%), non-alcoholic steatohepatitis ( n = 20, 12%), primary biliary cholangitis ( n = 15, 9%), acute liver failure ( n = 13, 8%), viral hepatitis ( n = 13, 8%) and autoimmune hepatitis ( n = 12, 7%). Early AS occurred in 25 (15%) cases, delayed in 32 (20%) cases and late in 95 (59%) cases. Age at transplant was 54 years (range, 12–74), and stent duration was 15 weeks (range, 3 days–78 weeks). In total, 131 (81%) had complete resolution of stricture at endoscopic re-evaluation. Stricture recurrence was observed in 13 (10%) cases, with a median of 19 weeks (range, 4–88 weeks) after stent removal. At removal, there were 21 (12%) adverse events, 5 (3%) episodes of cholangitis and 2 (1%) of pancreatitis. In 11 (6%) cases, the removal wires unravelled, and 3 (2%) stents migrated. All were removed endoscopically. Conclusion: IDSEMS appears to be safe and highly efficacious in the management of post-LT AS, with low rates of AS recurrence.
Databáze: Directory of Open Access Journals
Externí odkaz: