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• W2806775371 abstract "Biliary anastomotic strictures occur in 15-20% of patients following orthotopic liver transplantation (OLT). Placement of fully covered self-expandable metallic stent (cSEMS) for benign biliary disorders has been reported. The reduced number of procedures and cost is very appealing, however, adequate stent indwelling is not clearly defined. The aim of this study is to evaluate the efficacy and safety of cSEMS during a 1-year treatment for biliary anastomotic stricture (BAS) after OLT. This is a prospective observational cohort study, conducted in a tertiary care center in Brazil and is currently ongoing. Eligible participants were those with suspected BAS after deceased OLT without any previous treatment. Exclusion criteria were pregnancy, age under 18 years old, liver transplant within the past 30 days and inability to provide informed consent. A cSEMS was deployed after biliary sphincterotomy and was intended to be left in place for 1-year. The primary endpoint was stricture resolution at final ERCP, defined as waist disappearance during cholangiography and/or easy passage of an 11 mm extraction balloon. Between June 14 and November 2017, a total of 94 patients with post-OLT biliary complications were assessed for eligibility and 52 were included (Figure 1). Four patients discontinued intervention due to unrelated death (3) and retransplantation (1). Eighteen patients (37.5%) still have the stent in place. Overall stricture resolution was achieved in 39.5% (19/48) after a median follow-up of 279 days. In a best-case scenario, the success rate reaches 77.1% (37/48). Migration was the most common complication followed by acute pancreatitis, occurring in 33.3% and 10.4%, respectively. There were no deaths related to treatment (Table 1). Comparing the current results of endoscopic treatment with cSEMS for 1-year to our previously published data on the use of cSEMS for 6 months indwelling (Gastrointestinal Endoscopy, in press), a lower success rate was now noticed. Correlating the data of both studies we may interrogate if patients might have had the stricture resolved at some point between 6 and 12 months and presented stricture recurrence at scheduled stent removal. Fully covered metallic stents are a very appealing option for treating BAS after OLT. However, the optimal metal stent as well as the ideal indwelling are no available at this point. We were unable to demonstrate a benefit of leaving cSEMS for 1 year. Further studies are necessary to assess long-term outcomes.Tabled 1Summary of resultscSEMSN52Male : Female39:13AgeMean (range) years52.5 (26-69)Median (±SD)53.6 (± 11.5)Time from OLT to ERCPMean (range) days345.2 (31-3571)Median (±SD)125 (± 672.5)Stent indwellingMean (range) days296.3 (14-799)Median (±SD)369.5 ± 178.3Follow-upMean (range) days279.9 (2–800)Median (±SD)227 (± 207)Discontinued interventionUnrelated death3/52 (5.7%)Re-transplantation1/52 (1.9%)Stricture resolutionSuccess39.5% (19/48)In treatment37.5% (18/48)Failure22.9% (11/48)Best case scenario77.1 % (37/48)Stricture recurrence5.3% (1/19)Major ComplicationsDistal Migration33.3% (16/48)Proximal Migration2.1% (1/48)Acute pancreatitis10.4% (5/48)Cholangitis6.3% (3/48)Abdominal pain with hospitalization4.2% (2/48)Death related to ERCP procedure0 Open table in a new tab" @default.
• W2806775371 created "2018-06-13" @default.
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• W2806775371 date "2018-06-01" @default.
• W2806775371 modified "2023-10-14" @default.
• W2806775371 title "611 COVERED SELF-EXPANDABLE METALLIC STENTS FOR POST ORTHOTOPIC LIVER TRANSPLANT: IS 1-YEAR OF INDWELLING BETTER THAN 6 MONTHS?" @default.
• W2806775371 doi "https://doi.org/10.1016/j.gie.2018.04.125" @default.
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