TY - JOUR
T1 - Migration rate using Fully-covered metal stent in anastomotic strictures after liver transplantation: Results from the BASALT Study Group
AU - Conigliaro, Rita
AU - Pigò, Flavia
AU - Bertani, Helga
AU - Greco, Salvatore
AU - Burti, Cesare
AU - Indriolo, Amedeo
AU - Di Sario, Antonio
AU - Ortolani, Alessio
AU - Maroni, Luca
AU - Tringali, Andrea
AU - Barbaro, Federico
AU - Costamagna, Guido
AU - Magarotto, Andrea
AU - Masci, Enzo
AU - Mutignani, Massimiliano
AU - Forti, Edoardo
AU - Tringali, Alberto
AU - Parodi, Maria C.
AU - Assandri, Lorenzo
AU - Marrone, Ciro
AU - Fantin, Alberto
AU - Penagini, Roberto
AU - Cantù, Paolo
AU - Di Benedetto, Fabrizio
AU - Ravelli, Paolo
AU - Vivarelli, Marco
AU - Agnes, Salvatore
AU - Mazzaferro, Vincenzo
AU - De Carlis, Luciano
AU - Andorno, Enzo
AU - Cillo, Umberto
AU - Rossi, Giorgio
PY - 2022
Y1 - 2022
N2 - Background and study aim: The traditional endoscopic therapy of anastomotic strictures (AS) after
orthotopic liver transplantation (OLT) is multiple ERCPs with 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 analyze the results of AS endoscopic treatment by cSEMS and to identify any factors
associated to its success.
Patients and Methods
Ninety-one patients (mean age 55.9 ± 7.6 DS; 73 males) from 9 Italian transplantation centers, had a cSEMS
positioned for post-OLT AS between 2007 and 2017. 49 (54%) patients were treated with cSEMS as a
second-line treatment.
Results All the procedures were successfully performed without with no immediate complications. After
ERCP, adverse events occurred in 11% of cases (2 moderate pancreatitis, 8 cholangitis). In 49 patients
(54%) cSEMSs migrated. After cSEMS removal, 46 patients (51%) needed further endoscopic (45 patients)
or radiologic (1 patient) treatments to solve the AS. Lastly, 7 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.
AB - Background and study aim: The traditional endoscopic therapy of anastomotic strictures (AS) after
orthotopic liver transplantation (OLT) is multiple ERCPs with 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 analyze the results of AS endoscopic treatment by cSEMS and to identify any factors
associated to its success.
Patients and Methods
Ninety-one patients (mean age 55.9 ± 7.6 DS; 73 males) from 9 Italian transplantation centers, had a cSEMS
positioned for post-OLT AS between 2007 and 2017. 49 (54%) patients were treated with cSEMS as a
second-line treatment.
Results All the procedures were successfully performed without with no immediate complications. After
ERCP, adverse events occurred in 11% of cases (2 moderate pancreatitis, 8 cholangitis). In 49 patients
(54%) cSEMSs migrated. After cSEMS removal, 46 patients (51%) needed further endoscopic (45 patients)
or radiologic (1 patient) treatments to solve the AS. Lastly, 7 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.
KW - Anastomotic Biliary strictures
KW - Fully-covered self-expandable metal stents
KW - Liver transplantation
KW - Stent migration
KW - endoscopic retrograde cholangiopancreatography
KW - Anastomotic Biliary strictures
KW - Fully-covered self-expandable metal stents
KW - Liver transplantation
KW - Stent migration
KW - endoscopic retrograde cholangiopancreatography
UR - http://hdl.handle.net/10807/199184
U2 - 10.1111/liv.15246
DO - 10.1111/liv.15246
M3 - Article
SN - 1478-3223
SP - N/A-N/A
JO - Liver International
JF - Liver International
ER -