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

Background and study aim: The traditional endoscopic therapy of anastomotic strictures (AS) after\r\northotopic liver transplantation (OLT) is multiple ERCPs with insertion of an increasing number of plastic\r\nstents side-by-side. Fully covered self-expanding metal stents (cSEMS) could be a valuable option to\r\ndecrease the number of procedures needed or non-responders to plastic stents. This study aims to\r\nretrospectively analyze the results of AS endoscopic treatment by cSEMS and to identify any factors\r\nassociated to its success.\r\nPatients and Methods\r\nNinety-one patients (mean age 55.9 ± 7.6 DS; 73 males) from 9 Italian transplantation centers, had a cSEMS\r\npositioned for post-OLT AS between 2007 and 2017. 49 (54%) patients were treated with cSEMS as a\r\nsecond-line treatment.\r\nResults All the procedures were successfully performed without with no immediate complications. After\r\nERCP, adverse events occurred in 11% of cases (2 moderate pancreatitis, 8 cholangitis). In 49 patients\r\n(54%) cSEMSs migrated. After cSEMS removal, 46 patients (51%) needed further endoscopic (45 patients)\r\nor radiologic (1 patient) treatments to solve the AS. Lastly, 7 patients underwent surgery. Multivariable\r\nstepwise logistic regression showed that cSEMS migration was the only factor associated with further\r\ntreatments (OR 2.6, 95% CI 1.0-6.6; p-value 0.03); cSEMS implantation before 12 months from OLT was\r\nassociated with stent migration (OR 5.2, 95% CI 1.7-16.0; p-value 0.004).\r\nConclusions\r\ncSEMS appears to be a safe tool to treat AS. cSEMS migration is the main limitation to its routinary\r\nimplantation and needs to be prevented, probably with the use of new generation anti-migration stents.