CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(08): E914-E923
DOI: 10.1055/a-0626-7048
Review
Owner and Copyright © Georg Thieme Verlag KG 2018

Metallic vs plastic stents to treat biliary stricture after liver transplantation: a systematic review and meta-analysis based on randomized trials

Thiago Arantes de Carvalho Visconti
Department of Gastroenterology, Hospital das Clinicas from University of São Paulo Medical School, São Paulo, Brazil
,
Wanderley Marques Bernardo
Department of Gastroenterology, Hospital das Clinicas from University of São Paulo Medical School, São Paulo, Brazil
,
Diogo Turiani Hourneaux Moura
Department of Gastroenterology, Hospital das Clinicas from University of São Paulo Medical School, São Paulo, Brazil
,
Eduardo Turiani Hourneaux Moura
Department of Gastroenterology, Hospital das Clinicas from University of São Paulo Medical School, São Paulo, Brazil
,
Caio Vinicius Tranquillini Gonçalves
Department of Gastroenterology, Hospital das Clinicas from University of São Paulo Medical School, São Paulo, Brazil
,
Galileu Ferreira Farias
Department of Gastroenterology, Hospital das Clinicas from University of São Paulo Medical School, São Paulo, Brazil
,
Hugo Gonçalo Guedes
Department of Gastroenterology, Hospital das Clinicas from University of São Paulo Medical School, São Paulo, Brazil
,
Igor Braga Ribeiro
Department of Gastroenterology, Hospital das Clinicas from University of São Paulo Medical School, São Paulo, Brazil
,
Tomazo Prince Franzini
Department of Gastroenterology, Hospital das Clinicas from University of São Paulo Medical School, São Paulo, Brazil
,
Gustavo Oliveira Luz
Department of Gastroenterology, Hospital das Clinicas from University of São Paulo Medical School, São Paulo, Brazil
,
Marcos Eduardo dos Lera dos Santos
Department of Gastroenterology, Hospital das Clinicas from University of São Paulo Medical School, São Paulo, Brazil
,
Eduardo Guimarães Hourneaux de Moura
Department of Gastroenterology, Hospital das Clinicas from University of São Paulo Medical School, São Paulo, Brazil
› Author Affiliations
Further Information

Publication History

submitted 16 January 2018

accepted after revision 25 April 2018

Publication Date:
01 August 2018 (online)

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.