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Ahmed W, Kyle D, Khanna A, Devlin J, Reffitt D, Zeino Z, Webster G, Phillpotts S, Gordon R, Corbett G, Gelson W, Nayar M, Khan H, Cramp M, Potts J, Fateen W, Miller H, Paranandi B, Huggett M, Everett SM, Hegade VS, O’Kane R, Scott R, McDougall N, Harrison P, Joshi D. Intraductal fully covered self-expanding metal stents in the management of post-liver transplant anastomotic strictures: a UK wide experience. Therap Adv Gastroenterol 2022; 15:17562848221122473. [PMID: 36187366 PMCID: PMC9516418 DOI: 10.1177/17562848221122473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/24/2022] [Indexed: 02/04/2023] Open
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.
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Affiliation(s)
- Wafaa Ahmed
- Institute for Liver Studies, King’s College
Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Dave Kyle
- Institute of Liver Studies, King’s College
Hospital NHS Foundation Trust, London, UK
| | - Amardeep Khanna
- Institute of Liver Studies, King’s College
Hospital NHS Foundation Trust, London, UK
| | - John Devlin
- Institute of Liver Studies, King’s College
Hospital NHS Foundation Trust, London, UK
| | - David Reffitt
- Institute of Liver Studies, King’s College
Hospital NHS Foundation Trust, London, UK
| | - Zeino Zeino
- Southmead Hospital/North Bristol NHS Trust,
Bristol, UK
| | - George Webster
- Hepatopancreatobiliary Unit, University College
Hospital, London, UK
| | - Simon Phillpotts
- Hepatopancreatobiliary Unit, University College
Hospital, London, UK
| | - Robert Gordon
- Cambridge Liver Unit, Addenbrooke’s Hospital,
Cambridge, UK
| | - Gareth Corbett
- Cambridge Liver Unit, Addenbrooke’s Hospital,
Cambridge, UK
| | - William Gelson
- Cambridge Liver Unit, Addenbrooke’s Hospital,
Cambridge, UK
| | - Manu Nayar
- Freeman Hospital, Newcastle upon Tyne,
UK
| | - Haider Khan
- Southwest Liver Unit and Plymouth University
Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Matthew Cramp
- Southwest Liver Unit and Plymouth University
Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Jonathan Potts
- Royal Free Sheila Sherlock Liver Centre, Royal
Free Hospital and UCL Institute of Liver and Digestive Health, London,
UK
| | - Waleed Fateen
- Royal Free Sheila Sherlock Liver Centre, Royal
Free Hospital and UCL Institute of Liver and Digestive Health, London,
UK
| | - Hamish Miller
- Royal Free Sheila Sherlock Liver Centre, Royal
Free Hospital and UCL Institute of Liver and Digestive Health, London,
UK
| | | | | | | | | | | | - Ryan Scott
- Belfast Health and Social Care Trust, Belfast,
UK
| | | | - Phillip Harrison
- Institute of Liver Studies, King’s College
Hospital NHS Foundation Trust, London, UK
| | - Deepak Joshi
- Institute of Liver Studies, King’s College
Hospital NHS Foundation Trust, London, UK
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