Migration rate using Fully-covered metal stent in anastomotic strictures after liver transplantation: Results from the BASALT Study Group

Andrea Tringali, Guido Costamagna, Salvatore Agnes, Federico Barbaro, Rita Conigliaro, Flavia Pigò, Helga Bertani, Salvatore Greco, Cesare Burti, Amedeo Indriolo, Antonio Di Sario, Alessio Ortolani, Luca Maroni, Andrea Magarotto, Enzo Masci, Massimiliano Mutignani, Edoardo Forti, Alberto Tringali, Maria Caterina Parodi, Lorenzo AssandriCiro Marrone, Alberto Fantin, Roberto Penagini, Paolo Cantù, Fabrizio Di Benedetto, Paolo Ravelli, Marco Vivarelli, Vincenzo Mazzaferro, Luciano De Carlis, Enzo Andorno, Umberto Cillo, Giorgio Rossi

Risultato della ricerca: Contributo in rivistaArticolo in rivista

Abstract

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.
Lingua originaleEnglish
pagine (da-a)N/A-N/A
RivistaLiver International
DOI
Stato di pubblicazionePubblicato - 2022

Keywords

  • Anastomotic Biliary strictures
  • Fully-covered self-expandable metal stents
  • endoscopic retrograde cholangiopancreatography
  • Stent migration
  • Liver transplantation

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