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

⁰Pancreatobiliary Unit, University College London Hospitals, London, United Kingdom (Apostolis Papaefthymiou, Gavin Johnson, Simon Phillpotts, George Webster).

Annals of Gastroenterology +

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July 8, 2024

View abstract on PubMed

Summary

This study found no significant difference in stricture resolution or recurrence rates between self-expandable metal stents (SEMS) and multiple plastic stents (MPS) for post-liver transplant biliary strictures. Intraductal SEMS (ID-SEMS) were identified as the most cost-effective option.

Area Of Science

Gastroenterology
Hepatology
Interventional Endoscopy

Background

Anastomotic biliary strictures are a complication after liver transplantation.
Stent selection for endoscopic management remains debated.
Comparing multiple plastic stents (MPS) and self-expandable metal stents (SEMS) is crucial.

Purpose Of The Study

To systematically review and meta-analyze comparative studies on stent types for post-liver transplant biliary strictures.
To evaluate differences in efficacy and safety between MPS and various SEMS (fully-covered and intraductal).
To determine the most cost-effective stent strategy.

Main Methods

Systematic search of MEDLINE, Cochrane, and Scopus databases up to April 2023.
Inclusion of nine comparative studies with 687 patients.
Random-effects model meta-analysis of stricture resolution, recurrence, migration, and adverse events.

Main Results

No significant difference in stricture resolution between SEMS and MPS (OR 0.99, 95%CI 0.48-2.01).
Comparable rates of recurrence, migration, and adverse events between SEMS and MPS.
Intraductal SEMS (ID-SEMS) showed lower migration rates (OR 0.28, 95%CI 0.11-0.70) and fully-covered SEMS (FC-SEMS) had higher complication rates (OR 1.76, 95%CI 1.06-2.93) compared to MPS.
ID-SEMS demonstrated the highest cost-effectiveness (£3447.6/QALY).

Conclusions

Stent type does not impact stricture resolution or recurrence rates.
ID-SEMS represent the most cost-effective endoscopic management option for these strictures.
Further research may refine optimal stent selection based on specific patient and stricture characteristics.

Keywords:

Post-liver-transplant biliary strictures fully covered intraductal plastic stents self-expandable metal stents