Migration rate using fully covered metal stent in anastomotic strictures after liver transplantation: Results from the BASALT study group.

Abstract

BACKGROUND AND STUDY AIM:

The traditional endoscopic therapy of anastomotic strictures (AS) after orthotopic liver transplantation (OLT) is multiple ERCPs with the insertion of an increasing number of plastic stents side-by-side. Fully covered self-expanding metal stents (cSEMS) could be a valuable option to decrease the number of procedures needed or non-responders to plastic stents. This study aims to retrospectively analyse the results of AS endoscopic treatment by cSEMS and to identify any factors associated with its success.

PATIENTS AND METHODS:

Ninety-one patients (mean age 55.9 ± 7.6 SD; 73 males) from nine Italian transplantation centres, had a cSEMS positioned for post-OLT-AS between 2007 and 2017. Forty-nine (54%) patients were treated with cSEMS as a second-line treatment.

RESULTS:

All the procedures were successfully performed without immediate complications. After ERCP, adverse events occurred in 11% of cases (2 moderate pancreatitis and 8 cholangitis). In 49 patients (54%), cSEMSs migrated. After cSEMS removal, 46 patients (51%) needed further endoscopic (45 patients) or radiological (1 patient) treatments to solve the AS. Lastly, seven patients underwent surgery. Multivariable stepwise logistic regression showed that cSEMS migration was the only factor associated with further treatments (OR 2.6, 95% CI 1.0-6.6; p value 0.03); cSEMS implantation before 12 months from OLT was associated with stent migration (OR 5.2, 95% CI 1.7-16.0; p value 0.004).

CONCLUSIONS:

cSEMS appears to be a safe tool to treat AS. cSEMS migration is the main limitation to its routinary implantation and needs to be prevented, probably with the use of new generation anti-migration stents.

• Authors: Rita Conigliaro, Flavia Pigò, Helga Bertani, BASALT Group:, Salvatore Greco, Cesare Burti, Amedeo Indriolo, Antonio Di Sario, Alessio Ortolani, Luca Maroni, Andrea Tringali, Federico Barbaro, Guido Costamagna, Andrea Magarotto, Enzo Masci, Massimiliano Mutignani, Edoardo Forti, Alberto Tringali, Maria C Parodi, Lorenzo Assandri, Ciro Marrone, Alberto Fantin, Roberto Penagini, Paolo Cantù, Liver Transplant Centers:, Fabrizio Di Benedetto, Paolo Ravelli, Marco Vivarelli, Salvatore Agnes, Vincenzo Mazzaferro, Luciano De Carlis, Enzo Andorno, Umberto Cillo, Giorgio Rossi
• Journal: Liver international : official journal of the International Association for the Study of the Liver (Liver Int) Vol. 42 Issue 8 Pg. 1861-1871 (08 2022) ISSN: 1478-3231 [Electronic] United States
• PMID: 35302273 (Publication Type: Journal Article)
• Copyright: © 2022 John Wiley & Sons A/S . Published by John Wiley & Sons Ltd.

Chemical References

• Plastics
• Silicates
• basalt

Topics

• Cholangiopancreatography, Endoscopic Retrograde (adverse effects)
• Cholestasis (etiology, surgery)
• Constriction, Pathologic (surgery)
• Humans
• Liver Transplantation (adverse effects)
• Male
• Middle Aged
• Plastics
• Retrospective Studies
• Silicates
• Stents (adverse effects)
• Treatment Outcome