ORCID
- Cramp, Matthew: 0000-0002-1152-0568
Abstract
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.
DOI
10.1177/17562848221122473
Publication Date
2022-01-01
Publication Title
Therapeutic Advances in Gastroenterology
Volume
15
ISSN
1756-283X
Embargo Period
2022-11-03
Organisational Unit
Peninsula Medical School
Recommended Citation
Ahmed, W., Kyle, D., Khanna, A., Devlin, J., Reffitt, D., Zeino, Z., Webster, G., Phillpotts, S., Gordon, R., Corbett, G., Gelson, W., Nayar, M., Khan, H., Cramp, M., Potts, J., Fateen, W., Miller, H., Paranandi, B., Huggett, M., Everett, S., Hegade, V., O’Kane, R., Scott, R., McDougall, N., Harrison, P., & Joshi, D. (2022) 'Intraductal fully covered self-expanding metal stents in the management of post-liver transplant anastomotic strictures: a UK wide experience', Therapeutic Advances in Gastroenterology, 15. Available at: https://doi.org/10.1177/17562848221122473
