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.

CONFLICT OF INTEREST

Conflict of interest was declared by the authors.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available owing to privacy or ethical restrictions.

REFERENCES

1Londoño MC, Balderramo D, Cárdenas A. Management of biliary complications after orthotopic liver transplantation: the role of endoscopy. World J Gastroenterol. 2008; 14(4): 493.
10.3748/wjg.14.493
PubMed Web of Science® Google Scholar
2Aparicio DPDS, Otoch JP, Montero EFS, Khan MA, Artifon ELA. Endoscopic approach for management of biliary strictures in liver transplant recipients: a systematic review and meta-analysis. United European Gastroenterol J. 2017; 5: 827-845.
10.1177/2050640616681909
PubMed Web of Science® Google Scholar
3Park JS, Kim MH, Lee SK, et al. Efficacy of endoscopic and percutaneous treatments for biliary complications after cadaveric and living donor liver transplantation. Gastrointest Endosc. 2003; 57: 78-85.
10.1067/mge.2003.11
PubMed Web of Science® Google Scholar
4Zoepf T, Maldonado-Lopez EJ, Hilgard P, et al. Balloon dilatation vs. balloon dilatation plus bile duct endoprostheses for treatment of anastomotic biliary strictures after liver transplantation. Liver Transpl. 2006; 12: 88-94.
10.1002/lt.20548
PubMed Web of Science® Google Scholar
5Kaffes A, Griffin S, Vaughan R, et al. A randomized trial of a fully covered self-expandable metallic stent versus plastic stents in anastomotic biliary strictures after liver transplantation. Therap Adv Gastroenterol. 2014; 7: 64-71.
10.1177/1756283X13503614
PubMed Web of Science® Google Scholar
6Cantù P, Parzanese I, Balassone V, et al. Management of biliary anastomotic strictures after liver transplantation (BASALT study): a nationwide Italian survey. Liver Transpl. 2017; 23: 257-261.
10.1002/lt.24701
PubMed Web of Science® Google Scholar
7Poley JW, Lekkerkerker MN, Metselaar HJ, Kuipers EJ, Bruno MJ. Clinical outcome of progressive stenting in patients with anastomotic strictures after orthotopic liver transplantation. Endoscopy. 2013; 45: 567-570.
10.1055/s-0032-1326411
CAS PubMed Web of Science® Google Scholar
8Tarantino I, Traina M, Mocciaro F, et al. Fully covered SEMS for biliary stenosis after orthotopic liver transplantation. Endoscopy. 2012; 44: 246-250.
10.1055/s-0031-1291465
CAS PubMed Web of Science® Google Scholar
9Haapamaki C, Udd M, Halttunen J, Mäkisalo H, Kylänpää L. Endoscopic treatment of anastomotic biliary complications after liver transplantation using removable, covered, self-expandable metallic stents. Scand J Gastroenterol. 2012; 47: 116-121.
10.3109/00365521.2011.639082
PubMed Web of Science® Google Scholar
10Kahaleh M, Behm B, Clarke BW, et al. Temporary placement of covered self-expandable metal stents in benign biliary strictures: a new paradigm? (with video). Gastrointest Endosc. 2008; 67: 446-454.
10.1016/j.gie.2007.06.057
PubMed Web of Science® Google Scholar
11Tal AO, Finkelmeier F, Filmann N, et al. Multiple plastic stents versus covered metal stent for treatment of anastomotic biliary strictures after liver transplantation: a prospective, randomized, multicenter trial. Gastrointest Endosc. 2017; 86: 1038-1045.
10.1016/j.gie.2017.03.009
PubMed Web of Science® Google Scholar
12Dumonceau JM, Tringali A, Papanikolaou IS, et al. Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy. 2018; 50: 910-930.
10.1055/a-0659-9864
PubMed Web of Science® Google Scholar
13Cantù P, Tarantino I, Baldan A, Mutignani M, Tringali A, Lombardi G. Endo-therapies for biliary duct-to-duct anastomotic stricture after liver transplantation: outcomes of a nationwide survey. Liver Int. 2019; 39: 1355-1362.
10.1111/liv.14010
PubMed Web of Science® Google Scholar
14Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991; 37: 383-389.
10.1016/S0016-5107(91)70740-2
CAS PubMed Web of Science® Google Scholar
15Mayumi T, Okamoto K, Takada T, et al. Tokyo guidelines 2018: management bundles for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2018; 25: 96-100.
10.1002/jhbp.519
PubMed Web of Science® Google Scholar
16Coelho JCU, de Oliveira LL, Molena A, Freitas ACT, Matias JEF. Biliary complications after liver transplantation ABCD. Arq Bras Cir Dig. 2017; 30: 127-131.
10.1590/0102-6720201700020011
PubMed Web of Science® Google Scholar
17Costamagna G, Pandolfi M, Mutignani M, Spada C, Perri V. Long-term results of endoscopic management of postoperative bile duct strictures with increasing numbers of stents. Gastrointest Endosc. 2001; 54: 162-168.
10.1067/mge.2001.116876
CAS PubMed Web of Science® Google Scholar
18Tringali A, Barbaro F, Pizzicannella M, et al. Endoscopic management with multiple plastic stents of anastomotic biliary stricture following liver transplantation: long-term results. Endoscopy. 2016; 48(6): 546-551.
10.1055/s-0042-100277
PubMed Web of Science® Google Scholar
19Tarantino I, Amata M, Cicchese N, et al. Sequential multistenting protocol in biliary stenosis after liver transplantation: a prospective analysis. Endoscopy. 2019; 51(12): 1130-1135.
10.1055/a-0977-3158
PubMed Web of Science® Google Scholar
20Petersen BT, Koch J, Ginsberg GG. Infection using ERCP endoscopes. Gastroenterology. 2016; 151: 46-50.
10.1053/j.gastro.2016.05.040
PubMed Web of Science® Google Scholar
21Landi F, De Angelis N, Sepulveda A, et al. Endoscopic treatment of anastomotic biliary stricture after adult deceased donor liver transplantation with multiple plastic stents versus self-expandable metal stents: a systematic review and meta-analysis. Transpl Int 2018; 31: 131–151.
10.1111/tri.13089
PubMed Web of Science® Google Scholar
22Facciorusso A, Rosca EC, Ashimi A, et al. Management of anastomotic biliary stricture after liver transplantation: metal versus plastic stent. Ann Gastroenterol. 2018; 31: 728-734.
PubMed Web of Science® Google Scholar
23Poley JW, Ponchon T, Puespoek A, et al. Fully covered self-expanding metal stents for benign biliary stricture after orthotopic liver transplant: 5-year outcomes. Gastrointest Endosc. 2020; 92: 1216-1224.
10.1016/j.gie.2020.04.078
PubMed Web of Science® Google Scholar
24Aepli P, St John A, Gupta S, et al. Success and complications of an intraductal fully covered self-expanding metal stent (ID-FCSEMS) to treat an2020astomotic biliary strictures (AS) after orthotopic liver transplantation (OLT). Surg Endosc. 2017; 31: 1558-1563.
10.1007/s00464-016-5138-9
PubMed Web of Science® Google Scholar
25Jiménez-Pérez M, Melgar Simón GM, Durán CA, González Grande R, Rodrigo López JM, Manteca GR. Endoscopic Management of Post-Liver Transplantation Biliary Strictures with the use of fully covered metallic stents. Transplant Proc. 2016; 48: 2510-2514.
10.1016/j.transproceed.2016.09.008
CAS PubMed Web of Science® Google Scholar
26Tringali A, Tarantino I, Barresi L, et al. Multiple plastic versus fully covered metal stents for managing post-liver transplantation anastomotic biliary strictures: a meta-analysis of randomized controlled trials. Ann Gastroenterol. 2019; 32: 407-415.
PubMed Web of Science® Google Scholar
27Sauer P, Chahoud F, Gotthardt D, et al. Temporary placement of fully covered self/expandable metal stents in biliary complications after liver transplantation. Endoscopy. 2012; 44: 536-538.
10.1055/s-0031-1291714
CAS PubMed Web of Science® Google Scholar
28Tringali A, Blero D, Boškoski I, et al. Difficult removal of fully covered self expandable metal stents (SEMS) for benign biliary strictures: the "SEMS in SEMS" technique. Dig Liver Dis. 2014; 46: 568-571.
10.1016/j.dld.2014.02.018
PubMed Google Scholar
29Park DH, Lee SS, Lee TH, et al. Anchoring flap versus flared end, fully covered self-expandable metal stents to prevent migration in patients with benign biliary strictures: a multicenter, prospective, comparative pilot study (with videos). Gastrointest Endosc. 2011; 73: 64-70.
10.1016/j.gie.2010.09.039
PubMed Web of Science® Google Scholar
30Bordaçahar B, Perdigao F, Leblanc S, et al. Clinical efficacy of anti-migration features in fully covered metallic stents for anastomotic biliary strictures after liver transplantation: comparison of conventional and anti-migration stents. Gastrointest Endosc. 2018; 88: 655-664.
10.1016/j.gie.2018.06.035
PubMed Web of Science® Google Scholar
31Hu B, Leung JW, Gao DJ, Wang TT, Wu J. Management of benign biliary strictures with a novel retrievable selfexpandable metal stent. J Dig Dis. 2014; 15: 146-153.
10.1111/1751-2980.12117
CAS PubMed Web of Science® Google Scholar
32Jang S, Stevens T, Lopez R, et al. Self-expandable metallic stent is more cost efficient than plastic stent in treating anastomotic biliary stricture. Dig Dis Sci. 2020; 65: 600-608.
10.1007/s10620-019-05665-9
PubMed Web of Science® Google Scholar
33Coté GA, Slivka A, Tarnasky P, et al. Effect of covered metallic stents compared with plastic stents on benign biliary stricture resolution: a randomized clinical trial. Jama. 2016; 315: 1250-1257.
10.1001/jama.2016.2619
CAS PubMed Web of Science® Google Scholar
34Martins FP, Kahaleh M, Ferrari AP. Management of liver transplantation biliary stricture: results from a tertiary hospital. World J Gastrointest Endosc. 2015; 7: 747-757.
10.4253/wjge.v7.i7.747
PubMed Web of Science® Google Scholar
35Kahaleh M, Brijbassie A, Sethi A, et al. Multicenter trial evaluating the use of covered self-expanding metal stents in benign biliary strictures: time to revisit our therapeutic options? J Clin Gastroenterol. 2013; 47: 695-699.
10.1097/MCG.0b013e31827fd311
CAS PubMed Web of Science® Google Scholar
36Martins FP, De Paulo GA, Contini MLC, Ferrari AP. Metal versus plastic stents for anastomotic biliary strictures after liver transplantation: a randomized controlled trial. Gastrointest Endosc. 2018; 87: 131-138.
10.1016/j.gie.2017.04.013
PubMed Web of Science® Google Scholar
37Devière J, Reddy N, Püspök A, et al. Successful management of benign biliary strictures with fully covered self-expanding metal stents. Gastroenterology. 2014; 147: 385-395.
10.1053/j.gastro.2014.04.043
PubMed Web of Science® Google Scholar
38Kao D, Zepeda Gomez S, Tandon P, Bain VG. Managing the post–liver transplantation anastomotic biliary stricture: multiple plastic versus metal stents: a systematic review. Gatrointest Endosc. 2013; 77: 679-691.
10.1016/j.gie.2013.01.015
PubMed Web of Science® Google Scholar
39Jang S, Parsi MA, Lopez R, Bhatt A, Vargo JJ. Efficacy and optimal duration of metallic stent in the Management of Refractory Anastomotic Stricture after Liver Transplantation. Clin Gastroenterol Hepatol. 2017; 15: 1776-1781.
10.1016/j.cgh.2017.06.015
PubMed Web of Science® Google Scholar
40Tarantino I, Barresi L, Curcio G, et al. Definitive outcomes of self-expandable metal stents in patients with refractory post-transplant biliary anastomotic stenosis. Dig Liver Dis. 2015; 47: 562-565.
10.1016/j.dld.2015.03.001
PubMed Web of Science® Google Scholar
41Zeair S, Butkiewicz F, Butkiewicz J, Stasiuk R, et al. Application of fully covered self-expandable metallic stents with and without antimigration waist versus repeated plastic biliary stent placement in Management of Anastomotic Biliary Strictures after Orthotopic Liver Transplantation. Ann Transplant. 2017; 22: 719-724.
10.12659/AOT.905331
PubMed Web of Science® Google Scholar

Citing Literature

Volume42, Issue8

August 2022

Pages 1861-1871

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

Abstract

Background and Study Aim

Patients and Methods

Results

Conclusions

CONFLICT OF INTEREST

REFERENCES

Citing Literature

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

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

Abstract

Background and Study Aim

Patients and Methods

Results

Conclusions

CONFLICT OF INTEREST

REFERENCES

Citing Literature

References

Related

Information