Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA.
Dig Dis Sci. 2013 Sep;58(9):2661-6. doi: 10.1007/s10620-013-2703-0. Epub 2013 May 24.
Endoscopic treatment for biliary strictures with plastic stent placement has been used widely. The use of covered self-expandable metal stents (CSEMS) has been reported in anastomotic strictures post liver transplant. The aim of this study was to evaluate the efficacy of different CSEMS in these subjects.
A total of 55 patients with anastomotic stricture received CSEMS, which were removed after 3-4 months. There were 19 patients in group A (partially covered SEMS), 21 patients in group B (fully covered SEMS with fins) and 15 patients in group C (fully covered SEMS with flared ends). Technical success, stricture resolution, follows up, and complications were documented.
CSEMS were successfully deployed in all 55 cases. There was no evidence of significant difference with regards to stricture resolution (14 [74%] vs. 15 [71%] vs. 9 [60%] p=0.6630, df=2) or complications between groups. Stent-related complications were as follows: three in group A (2 migration, 1 occlusion), five in group B (4 occlusions, 1 migration), and one proximal migration in group C (p=0.3894, df=2). Three cases required surgery (hepatico-jejunostomy) due to refractory strictures.
The observed clinical success rate of CSEMS (70.4%) proved to be below the reported one for multiple plastic stents, while no significant differences between CSEMS types were observed.
内镜下胆道塑料支架置入术已广泛应用于治疗胆道狭窄。有报道称，在肝移植术后吻合口狭窄中使用覆膜自膨式金属支架（CSEMS）。本研究旨在评估不同 CSEMS 在这些患者中的疗效。
共 55 例吻合口狭窄患者接受 CSEMS 治疗，3-4 个月后取出。A 组 19 例（部分覆膜 SEMS），B 组 21 例（带翼鳍的完全覆膜 SEMS），C 组 15 例（带喇叭口的完全覆膜 SEMS）。记录技术成功率、狭窄缓解、随访和并发症情况。
55 例患者均成功植入 CSEMS。在狭窄缓解方面，三组间无显著差异（14[74%]例 vs. 15[71%]例 vs. 9[60%]例，p=0.6630，df=2）或并发症发生率。支架相关并发症如下：A 组 3 例（2 例迁移，1 例阻塞），B 组 5 例（4 例阻塞，1 例迁移），C 组 1 例近端迁移（p=0.3894，df=2）。由于难治性狭窄，有 3 例需要手术（胆肠吻合术）。
CSEMS 的观察临床成功率（70.4%）低于多次使用塑料支架的报道成功率，且三种 CSEMS 类型之间无显著差异。
