Abstract
Background and study aims The first-line approach to anastomotic biliary stricture after orthotopic liver transplantation
(OLTX) involves endoscopic retrograde cholangiopancreatography (ERCP). The most widely
used technique is placement of multiple plastic stents, but discussions are ongoing
on the benefits of fully-covered self-expandable metallic stents (FCEMS) in this situation.
This study aimed to compare results from use of plastic and metal stents to treat
biliary stricture after transplantation.
Patients and methods Searches were performed in the Medline, EMBASE, SciELO/LILACS, and Cochrane databases,
and only randomized studies comparing the two techniques were included in the meta-analysis.
Results Our study included four randomized clinical trials totaling 205 patients. No difference
was observed between the stricture resolution rate (RD: 0.01; 95 %CI [−0.08 – 0.10]),
stricture recurrence (RD: 0.13; 95 %CI [−0.03 – 0.28]), and adverse events (RD: −0.10;
95 %CI [−0.65 – 0.44]) between the plastic and metallic stent groups. The metallic
stent group demonstrated benefits in relation to the number of ERCPs performed (MD:
−1.86; 95 %CI [−3.12 to −0.6]), duration of treatment (MD: −105.07; 95 %CI [−202.38
to −7.76 days]), number of stents used (MD: −10.633; 95 %CI [−20.82 to −0.44]), and
cost (average $ 8,288.50 versus $ 18,580.00, P < 0.001).
Conclusions Rates of resolution and recurrence of stricture are similar, whereas the number of
ERCPs performed, number of stents used, duration of treatment, and costs were lower
in patients treated with FCEMS, which shows that this device is a valid option for
initial treatment of post-OLTX biliary stricture.
