Endoscopy 2018; 50(04): S70-S71
DOI: 10.1055/s-0038-1637236
ESGE Days 2018 oral presentations
21.04.2018 – ERCP 3: Hot topics and post liver transplantation
Georg Thieme Verlag KG Stuttgart · New York

CLINICAL EFFICACY OF ANTI-MIGRATION FEATURES IN FULLY-COVERED SELF-EXPANDABLE METALLIC STENTS FOR ANASTOMOTIC BILIARY STRICTURES AFTER LIVER TRANSPLANTATION

B Bordaçahar
1   Hopital Cochin, Gastroenterology and Endoscopy Unit, Paris, France
,
F Perdigao
2   Hopital Pitié Salpétrière, Digestive Surgery Department, Paris, France
,
S Leblanc
1   Hopital Cochin, Gastroenterology and Endoscopy Unit, Paris, France
,
M Barret
1   Hopital Cochin, Gastroenterology and Endoscopy Unit, Paris, France
,
JC Duchmann
1   Hopital Cochin, Gastroenterology and Endoscopy Unit, Paris, France
,
MA Guillaumot
1   Hopital Cochin, Gastroenterology and Endoscopy Unit, Paris, France
,
S Chaussade
1   Hopital Cochin, Gastroenterology and Endoscopy Unit, Paris, France
,
O Scatton
2   Hopital Pitié Salpétrière, Digestive Surgery Department, Paris, France
,
F Prat
1   Hopital Cochin, Gastroenterology and Endoscopy Unit, Paris, France
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

Also available at
 

Aims:

Anastomotic biliary strictures (ABS) are one of the most frequent adverse effects occurring after orthotopic liver transplantation (OLT). Fully-covered self-expandable metallic stents (FCSEMS) have been used with positive outcomes but also a high rate of migration which may limit success.

Our primary objective was to compare stent migration rates observed with “standard” FCSEMS (Std-FCSEMS) and so-called “anti-migration” FCSEMS (Am-FCSEMS). Secondary objectives were to compare the rates of stricture resolution and procedure-related morbidity.

Methods:

We conducted a retrospective analysis of a subset of patients (FCSEMS for post-OLT ABS) from 2 prospectively maintained databases of a) OLT patients, and b) ERCP and stenting. Between 2009 and 2016, consecutive patients presenting with ABS after OLT referred to Cochin Hospital (Paris, France) for ERCP and receiving an FCSEMS were included. Exclusion criteria were any other cause of biliary stricture (malignant stricture, ischemic origin), and biliary fistulae.

Results:

One hundred and twenty-five FCSEMS (57 Am-FCSEMS, 68 Std-FCSEMS) were used in 75 patients for ABS after OLT. Patient characteristics and rates of previous endoscopic treatment were not no different between groups. The rate of FCSEMS complete migration was 16% (20/125), respectively 1.7% (1/57) for Am-FCSEMS and 28% (19/68) for Std-FCSEMS (p < 0.0001).

An early endoscopic revision for cholestasis or acute cholangitis was necessary in 24.8% (31/125) of cases, respectively 12.2% (7/57) for Am-FCSEMS and 35.3% (24/68) for Std-FCSEMS (p = 0.005). All attempted stent removals (100% of patients) were successful. First follow-up ERCP after each FCSEMS highlighted a stricture resolution rate of 78.4% (98/125), respectively 93% (53/57) for Am-FCSEMS and 66.2% (45/68) for Std-FCSEMS (p < 0.001).

Procedure-related morbidity was not different between groups.

Conclusions:

In patients with ABS after OLT, the use of Am-FC-SEMS significantly decreased the risk of stent migration and improved sustained stricture resolution. Endoscopic removal success and procedure-related morbidity were similar for both standard and anti-migration stents.