Therapeutic Advances in Gastroenterology (Sep 2022)

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

  • Wafaa Ahmed,
  • Dave Kyle,
  • Amardeep Khanna,
  • John Devlin,
  • David Reffitt,
  • Zeino Zeino,
  • George Webster,
  • Simon Phillpotts,
  • Robert Gordon,
  • Gareth Corbett,
  • William Gelson,
  • Manu Nayar,
  • Haider Khan,
  • Matthew Cramp,
  • Jonathan Potts,
  • Waleed Fateen,
  • Hamish Miller,
  • Bharat Paranandi,
  • Matthew Huggett,
  • Simon M. Everett,
  • Vinod S. Hegade,
  • Rebecca O’Kane,
  • Ryan Scott,
  • Neil McDougall,
  • Phillip Harrison,
  • Deepak Joshi

DOI
https://doi.org/10.1177/17562848221122473
Journal volume & issue
Vol. 15

Abstract

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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.