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. 2024 Jul-Aug;37(4):485-492.
doi: 10.20524/aog.2024.0886. Epub 2024 Jun 14.

Efficacy of different stent types in post-liver-transplant anastomotic biliary strictures: a systematic review and meta-analysis

Apostolis Papaefthymiou  1 , Daryl Ramai  2 , Marcello Maida  3 , Georgios Tziatzios  4 , Antonio Facciorusso  5 , Konstantinos Triantafyllou  6 , Marianna Arvanitakis  7 , Gavin Johnson  1 , Simon Phillpotts  1 , George Webster  1 , Paraskevas Gkolfakis  4   7
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Efficacy of different stent types in post-liver-transplant anastomotic biliary strictures: a systematic review and meta-analysis

Apostolis Papaefthymiou et al. Ann Gastroenterol. 2024 Jul-Aug.

Abstract

Background: Stent selection in the endoscopic management of post-liver-transplant anastomotic biliary strictures remains controversial. This systematic review and meta-analysis aimed to evaluate the potential differences between available stents.

Methods: MEDLINE, Cochrane, and Scopus databases were searched until April 2023 for comparative studies evaluating stricture management using multiple plastic stents (MPS) and self-expandable metal stents (SEMS), including fully-covered (FC)- and intraductal (ID)-SEMS. The primary outcome was stricture resolution, while secondary outcomes included stricture recurrence, stent migration and adverse events. Meta-analyses were based on a random-effects model and the results were reported as odds ratios (OR) with 95% confidence intervals (CI). Subgroup analyses by type of metal stent and a cost-effectiveness analysis were also performed.

Results: Nine studies (687 patients) were finally included. Considering stricture resolution, SEMS and MPS did not differ significantly (OR 0.99, 95%CI 0.48-2.01; I 2=35%). Stricture recurrence, migration rates and adverse events were also comparable (OR 1.71, 95%CI 0.87-3.38; I 2=55%, OR 0.73, 95%CI 0.32-1.68; I 2=56%, and OR 1.47, 95%CI 0.89-2.43; I 2=24%, respectively). In the subgroup analysis, stricture resolution and recurrence rates did not differ for ID-SEMS vs. MPS or FC-SEMS vs. MPS. Migration rates were lower for ID-SEMS compared to MPS (OR 0.28, 95%CI 0.11-0.70; I 2=0%), and complication rates were higher after FC-SEMS compared to MPS (OR 1.76, 95%CI 1.06-2.93; I 2=0%). Finally, ID-SEMS were the most cost-effective approach, with the lowest incremental cost-effectiveness ratio: 3447.6 £/QALY.

Conclusion: Stent type did not affect stricture resolution and recurrence; however, ID-SEMS placement was the most cost-effective approach compared to the alternatives.

Keywords: Post-liver-transplant biliary strictures; fully covered; intraductal; plastic stents; self-expandable metal stents.

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Conflict of interest statement

Conflict of Interest: None

Figures

Figure 1
Figure 1
Study flowchart
Figure 2
Figure 2
Forest plot reporting the odds ratios of stricture resolution rates between self-expandable metal stents (SEMS) and multiple plastic stents (MPS) M-H, Mantel-Haenszel; CI, confidence interval
See this image and copyright information in PMC

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