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DOI: 10.1055/s-0038-1637235
MULTIPLE PLASTIC STENT (MPS) VERSUS FCSEMS FOR MANAGING POST LIVER TRANSPLANTATION BILIARY STRICTURE: A SYSTEMATIC REVIEW AND META-ANLAYSIS OF RANDOMIZED CONTROLLED TRIAL
Publication History
Publication Date:
27 March 2018 (online)
Aims:
Anastomotic stricture post liver trasnplasntation (LT) are one of the most common complications occuring in 4.5 – 32% of case. Multiple plastic stenting (MPS) has become the standard of endoscopic treatment but require multiple session with associated risk, cost and patients discomfort. Fully covered self expandable metal stent (FCSEMS) has been increasingly used in this setting. A recent systematic review including prospective studies did not evidence a clear advantage in using FCSEMS.
Aim:
A systematic review and meta-analysis of RCT comparing the role of FCSEMS and MPS in the treatment of AS post LT
Methods:
we conducted a bibliographic search using PUBMED, EMBASE aimed at identifying available randomized trials comparing MPS versus FCSEMS in patients with AS post LTe from January 2000 to October 2017. Primary outcomes were stricture resolution, while secondary outcomes were recurrence rate, adverse events and number of procedure performed. Pooled estimates were computed using the random effects models
Results:
Overall 3 RCTS, involving 127 patients were included. Stricture resolution and stricture recurrence were not statistically difference in both groups (OR = 0.58, 95% CI0.07 – 4.85; OR = 1.97, 95% CI, 0.29 – 13.18, respectively). There was no difference in adverse events in both groups (OR 0.83 95% CI 0.19 – 3.67). Migration rate were equal in both groups (OR 1.34 95% CI 0.17 – 10.42) Mean number of ERCP procedure were greater in the FCSEMS (MD -2.83 95% CI -3.04- -2.63)
Conclusions:
FCSEMS and MPS had equal stricture resolution and recurrence rate. No difference was found in advere events and migration rate. FCSEMS require less number of procedure to achieve a stricture resolution.