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. 2022 Sep 26:15:17562848221122473.
doi: 10.1177/17562848221122473. eCollection 2022.

Intraductal fully covered self-expanding metal stents in the management of post-liver transplant anastomotic strictures: a UK wide experience

Wafaa Ahmed  1 , Dave Kyle  2 , Amardeep Khanna  2 , John Devlin  2 , David Reffitt  2 , Zeino Zeino  3 , George Webster  4 , Simon Phillpotts  4 , Robert Gordon  5 , Gareth Corbett  5 , William Gelson  5 , Manu Nayar  6 , Haider Khan  7 , Matthew Cramp  7 , Jonathan Potts  8 , Waleed Fateen  8 , Hamish Miller  8 , Bharat Paranandi  9 , Matthew Huggett  9 , Simon M Everett  9 , Vinod S Hegade  9 , Rebecca O'Kane  10 , Ryan Scott  10 , Neil McDougall  10 , Phillip Harrison  2 , Deepak Joshi  2
Affiliations

Intraductal fully covered self-expanding metal stents in the management of post-liver transplant anastomotic strictures: a UK wide experience

Wafaa Ahmed et al. Therap Adv Gastroenterol. .

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.

Keywords: ERCP; biliary stricture; intra-ductal fully covered metal stent; liver transplant.

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Conflict of interest statement

Competing interests: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
IDSEMS insertion in a post-LT setting with resolution of AS. (Three sequential images uploaded under the heading of Figure 1 on the upload portal.) AS, anastomotic stricture; IDSEMS, intraductal self-expanding metal stent; LT, liver transplant.
Figure 2.
Figure 2.
Resolution of AS with IDSEMS. AS, anastomotic stricture; IDSEMS, intraductal self-expanding metal stent.
See this image and copyright information in PMC

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