Fully Covered Metal Stents Provide Respectable Efficacy for Posttransplant Strictures

Fully Covered Metal Stents Provide Respectable Efficacy for Posttransplant Strictures

Bret T. Petersen, MD, MASGE, reviewing Poley JW, et al. Gastrointest Endosc 2020 May 15.

Biliary leaks and strictures are among the most common adverse events after liver transplantation. Anastomotic strictures are generally managed using endoscopic balloon dilation and stenting with multiple plastic stents or single, fully covered, self-expanding metal stents (FCSEMS) over a number of months. 

This report provides 5-year follow-up data on a prospective, multicenter study from the industry-sponsored Benign Biliary Stenoses Working Group. Patients with anastomotic strictures after orthotopic liver transplantation were treated with a commercially available FCSEMS for 4 to 6 months, then followed for 5 years or until stricture recurrence, with documentation of stent-related serious adverse events, stricture recurrence, and need for stent replacement after initial therapy. 

Among 41 patients, 33 had their stents removed per protocol and 8 were noted to experience spontaneous complete migration from the biliary tree. After stent removal or spontaneous passage, the 5-year probability of remaining stent-free was 48.9% (95% confidence interval [CI], 33.2%-64.7%) on an intention-to-treat basis for all patients. Five-year stent-free intervals were more common among those groups with longer stent retention (60.9% for retention >4 months in 31 patients; 95% CI, 43.6%−78.2%) and those with complete stricture resolution (72.6% for 28 patients, with a median dwell time of 5.0 months; 95% CI, 55.3%−90%). Ten patients experienced cholangitis, and 1 or more severe adverse events occurred in 16 patients (39%).

Bret T. Petersen, MD, FASGE

COMMENT

The use of multiple plastic stents versus FCSEMS for palliation of anastomotic strictures after liver transplantation has been the subject of several randomized trials and meta-analyses, with mixed results favoring one or the other approach. Long-term efficacy data for FCSEMS therapy have not been available until now. In this industry-sponsored study, 70% of patients with stricture resolution after a median of 5.0 months of stent therapy remained stent-free for 5 years. Not addressed, but undoubtedly important, is the likelihood of lower procedural burden and expense with placement of a single stent on one occasion.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Poley JW, Ponchon T, Puespoek A, et al; Benign Biliary Stenoses Working Group. Fully covered self-expanding metal stents for benign biliary stricture after orthotopic liver transplant: 5-year outcomes. Gastrointest Endosc 2020 May 15. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2020.04.078)

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