CONVENTIONAL VS ANTIMIGRATION FULLY COVERED METAL STENT (FCMS) FOR ENDOTHERAPY OF BILIARY ANASTOMOTIC STRICTURE (BAS) FOLLOWING DECEASED-DONOR LIVER TRANSPLANTATION (LT)

Aims Antimigration FCMS (A-FCMS) might enhance endotherapy of BAS.

Methods Retrospective cohort study of consecutive LT patients receiving endotherapy for choledocho-choledochostomy BAS with conventional FCMS (C-FCMS) or A-FCMS between 2005-2020 at single tertiary-center. Previous biliary plastic stent placements were also included. Patients were classified according to FCMS type on index ERCP. Primary outcomes: migration and resolution rates on first endoscopic revision. Secondary outcomes: initial/final resolution and recurrence rates.

Results 651 patients underwent LT during the study period; 118 BAS patients (79% male; median [IQR] age of 57.5 [50.2-62.7] years) were included. 48 patients received a total of 58 C-FCMS, 70 patients received 93 A-FCMS. 10x80 mm was the most common FCMS size (81.4%). Median time from LT to index ERCP was 8 months (IQR 3-21). Baseline features were comparable, except that C-FCMS had higher rates of previous plastic stent [27 (56.3% vs 24 (34.3%), p=0.02]. A-FCMS patients presented a lower migration rate on first endoscopic revision, similar resolution rates on first endoscopic revision and at the end of treatment; A-FCMS dwell time for each stent was significantly longer.

After a median follow-up of 52 months (IQR 17-89), BAS recurrence was observed in 26 patients (22%), with a higher rate in C-FCMS patients [14 (29.2%) vs 12 (17.1), p=0.27]. Patients with BAS recurrence had shorter stent dwell time [6 (4-8) months vs 7 (5-13.5), p=0.02].

Table 1

PATIENTS	Total N=118	C-FCMS N=48 (%)	A-FCMS N=70 (%)	p
Migration 1st revision	30 (24.5)	18 (37.5)	12 (17.1)	0.04
Resolution 1st revision	62 (52.2)	24 (50)	38 (54.3)	088
Final resolution	105 (89)	43 (89.3)	62 (88.6)	0.86
STENTS Individual stent dwell time (IQR), months	Total N=151 5 (2-7)	C-FCMS n=58 3(2-6)	A-FCMS n=93 5 (2-7)	0.03

Conclusions A-FCMS are associated with lower migration rates, longer stent dwell time and lower late BAS recurrence rates compared to C-FCMS in LT patients undergoing endotherapy.

Publication History

Article published online:
14 April 2022