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Papaefthymiou A, Ramai D, Maida M, Tziatzios G, Facciorusso A, Triantafyllou K, Arvanitakis M, Johnson G, Phillpotts S, Webster G, Gkolfakis P. Efficacy of different stent types in post-liver-transplant anastomotic biliary strictures: a systematic review and meta-analysis. Ann Gastroenterol 2024; 37:485-492. [PMID: 38974085 PMCID: PMC11226740 DOI: 10.20524/aog.2024.0886] [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: 02/28/2024] [Accepted: 05/10/2024] [Indexed: 07/09/2024] Open
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.
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Affiliation(s)
- Apostolis Papaefthymiou
- Pancreatobiliary Unit, University College London Hospitals, London, United Kingdom (Apostolis Papaefthymiou, Gavin Johnson, Simon Phillpotts, George Webster)
| | - Daryl Ramai
- Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT, USA (Daryl Ramai)
| | - Marcello Maida
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, Caltanissetta, Italy (Marcello Maida)
| | - Georgios Tziatzios
- Department of Gastroenterology, “Konstantopoulio-Patision” General Hospital of Nea Ionia, Athens, Greece (Georgios Tziatzios, Paraskevas Gkolfakis)
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Italy (Antonio Facciorusso)
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutics, Medical School, National and Kapodistrian University of Athens, Greece (Konstantinos Triantafyllou)
| | - Marianna Arvanitakis
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, ULB, Brussels, Belgium (Marianna Arvanitakis, Paraskevas Gkolfakis)
| | - Gavin Johnson
- Pancreatobiliary Unit, University College London Hospitals, London, United Kingdom (Apostolis Papaefthymiou, Gavin Johnson, Simon Phillpotts, George Webster)
| | - Simon Phillpotts
- Pancreatobiliary Unit, University College London Hospitals, London, United Kingdom (Apostolis Papaefthymiou, Gavin Johnson, Simon Phillpotts, George Webster)
| | - George Webster
- Pancreatobiliary Unit, University College London Hospitals, London, United Kingdom (Apostolis Papaefthymiou, Gavin Johnson, Simon Phillpotts, George Webster)
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, “Konstantopoulio-Patision” General Hospital of Nea Ionia, Athens, Greece (Georgios Tziatzios, Paraskevas Gkolfakis)
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, ULB, Brussels, Belgium (Marianna Arvanitakis, Paraskevas Gkolfakis)
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Nve E, Badia JM, Amillo-Zaragüeta M, Juvany M, Mourelo-Fariña M, Jorba R. Early Management of Severe Biliary Infection in the Era of the Tokyo Guidelines. J Clin Med 2023; 12:4711. [PMID: 37510826 PMCID: PMC10380792 DOI: 10.3390/jcm12144711] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 06/28/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
Sepsis of biliary origin is increasing worldwide and has become one of the leading causes of emergency department admissions. The presence of multi-resistant bacteria (MRB) is increasing, and mortality rates may reach 20%. This review focuses on the changes induced by the Tokyo guidelines and new concepts related to the early treatment of severe biliary disease. If cholecystitis or cholangitis is suspected, ultrasound is the imaging test of choice. Appropriate empirical antibiotic treatment should be initiated promptly, and selection should be performed while bearing in mind the severity and risk factors for MRB. In acute cholecystitis, laparoscopic cholecystectomy is the main therapeutic intervention. In patients not suitable for surgery, percutaneous cholecystostomy is a valid alternative for controlling the infection. Treatment of severe acute cholangitis is based on endoscopic or transhepatic bile duct drainage and antibiotic therapy. Endoscopic ultrasound and other new endoscopic techniques have been added to the arsenal as novel alternatives in high-risk patients. However, biliary infections remain serious conditions that can lead to sepsis and death. The introduction of internationally accepted guidelines, based on clinical presentation, laboratory tests, and imaging, provides a framework for their rapid diagnosis and treatment. Prompt assessment of patient severity, timely initiation of antimicrobials, and early control of the source of infection are essential to reduce morbidity and mortality rates.
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Affiliation(s)
- Esther Nve
- Department of Surgery, Hospital Universitari Mútua de Terrassa, 08221 Barcelona, Spain;
- School of Medicine, Universitat Rovira i Virgili, 43003 Tarragona, Spain;
| | - Josep M. Badia
- Department of Surgery, Hospital General Granollers, School of Medicine, Universitat Internacional de Catalunya, Av Francesc Ribas 1, 08402 Granollers, Spain; (M.A.-Z.); (M.J.)
| | - Mireia Amillo-Zaragüeta
- Department of Surgery, Hospital General Granollers, School of Medicine, Universitat Internacional de Catalunya, Av Francesc Ribas 1, 08402 Granollers, Spain; (M.A.-Z.); (M.J.)
| | - Montserrat Juvany
- Department of Surgery, Hospital General Granollers, School of Medicine, Universitat Internacional de Catalunya, Av Francesc Ribas 1, 08402 Granollers, Spain; (M.A.-Z.); (M.J.)
| | - Mónica Mourelo-Fariña
- Intensive Care Unit, Complexo Hospitalario Universitario A Coruña, 15006 A Coruña, Spain;
| | - Rosa Jorba
- School of Medicine, Universitat Rovira i Virgili, 43003 Tarragona, Spain;
- Department of Surgery, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
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Obed A, Bashir A, Jarrad A, Fuzesi L. Role of biliary complications in chronic graft rejection after living donor liver transplantation. World J Hepatol 2022; 14:1050-1052. [PMID: 35721291 PMCID: PMC9157706 DOI: 10.4254/wjh.v14.i5.1050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/14/2022] [Accepted: 04/28/2022] [Indexed: 02/06/2023] Open
Abstract
Postoperative biliary complications remain a substantial challenge after living donor liver transplantation, especially due to its heterogeneous clinical presentation.
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Affiliation(s)
- Aiman Obed
- Hepatobiliary and Liver Transplant Unit, Jordan Hospital, Amman 52112, Jordan
| | - Abdalla Bashir
- Department of General Surgery, Jordan Hospital, Amman 52112, Jordan
| | - Anwar Jarrad
- Department of Hepatology, Jordan Hospital, Amman 52112, Jordan
| | - Laszlo Fuzesi
- Department of Pathology, Faculty of Medicine, University Augsburg, Augsburg 86156, Germany
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