Open AccessEndoscopic treatment of anastomotic biliary stricture after adult deceased donor liver transplantation with multiple plastic stents versus self‐expandable metal stents: a systematic review and meta‐analysis
Author(s) -
Landi Filippo,
de'Angelis Nicola,
Sepulveda Ailton,
MartínezPérez Aleix,
Sobhani Iradj,
Laurent Alexis,
Soubrane Olivier
Publication year - 2018
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.13089
Subject(s) - medicine , liver transplantation , anastomosis , surgery , meta analysis , retrospective cohort study , biliary tract surgical procedures , transplantation , self expandable metallic stent , randomized controlled trial , cohort , stent , biliary tract
Summary Anastomotic biliary strictures ( ABS s) occur in up to 15% of patients after liver transplantation ( LT ). The aim of this study was to compare the efficacy and safety of self‐expandable metal stents ( SEMS ) versus multiple plastic stents ( MPS ). Databases were searched through April 2017. The outcome measures were technical success, stricture resolution, recurrence and complications. We synthesized the findings descriptively and performed a meta‐analysis. Three randomized controlled trials and one retrospective cohort study were identified, including 179 MPS and 119 SEMS patients. Outcome data were pooled in a meta‐analysis that showed an advantage of SEMS in terms of the number of ERCP procedures (mean difference: 1.69 ERCP ; 95% CI , 1–2.39; P < 0.00001) and treatment days (mean difference: 40.2 days; 95% CI , 3.9–76.4; P = 0.03), with no differences in terms of ABS resolution or recurrence. Fourteen case series reported MPS outcomes and fifteen reported SEMS outcomes, including 647 and 419 patients, respectively. Based on low‐quality evidence, we cannot draw any reliable conclusions on the superiority of MPS or SEMS strategies. Even though shorter treatment times and fewer ERCP procedures support the use of SEMS , whether one technique has well‐defined advantages over the other remains unclear.