Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio.
Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio.
Clin Gastroenterol Hepatol. 2017 Nov;15(11):1776-1781. doi: 10.1016/j.cgh.2017.06.015. Epub 2017 Jun 15.
BACKGROUND & AIMS: Anastomotic bile duct stricture (ABS) remains as one of the most common complications in liver transplant patients. Current practice of endoscopic retrograde cholangiopancreatography (ERCP) with insertion of plastic stent often requires multiple procedures before achieving stricture resolution. To date, studies using covered self-expandable metallic stent (cSEMS) in ABS management reported varying degrees of efficacy. The aim of this study was to analyze long-term efficacy of cSEMS in patients with ABS and identify factor(s) influencing the probability of stricture resolution.
Liver transplant patients with ABS who received cSEMS were identified by query of our endoscopic database. The rate of stricture resolution, duration of stricture-free interval, factors associated with stricture resolution, and adverse outcomes were analyzed.
Among 44 liver transplant patients with refractory ABS who underwent ERCP-cSEMS, stricture resolution was observed in 33 patients (75%). Longer duration of cSEMS insertion was the only variable associated with increasing probability of stricture resolution. There was 20% increase in odds of stricture resolution for every additional week cSEMS was in place. Among 33 patients with initial stricture resolution, 26 patients (78.8%) maintained bile duct patency throughout the follow-up period. The most common adverse outcome was internal migration of cSEMS, which occurred in 11 patients (25%).
The rate of ABS resolution observed with cSEMS placement in a single ERCP session appears to be comparable with that of multiple ERCPs with plastic stent placement reported previously. Longer stent insertion period is associated with higher likelihood of ABS resolution.
吻合口胆管狭窄（ABS）仍然是肝移植患者最常见的并发症之一。目前，经内镜逆行胰胆管造影术（ERCP）联合塑料支架置入术治疗 ABS 往往需要多次操作才能解决狭窄问题。迄今为止，使用覆膜自膨式金属支架（cSEMS）治疗 ABS 的研究报告了不同程度的疗效。本研究旨在分析 cSEMS 治疗 ABS 患者的长期疗效，并确定影响狭窄缓解概率的因素。
通过查询内镜数据库，确定接受 cSEMS 治疗的 ABS 肝移植患者。分析狭窄缓解率、无狭窄间隔持续时间、与狭窄缓解相关的因素以及不良结局。
在 44 例接受 ERCP-cSEMS 治疗的难治性 ABS 肝移植患者中，33 例（75%）观察到狭窄缓解。cSEMS 插入时间较长是唯一与增加狭窄缓解概率相关的变量。cSEMS 每多放置一周，狭窄缓解的几率就会增加 20%。在 33 例初始狭窄缓解的患者中，26 例（78.8%）在整个随访期间保持胆管通畅。最常见的不良结局是 cSEMS 内移，共 11 例（25%）。
单次 ERCP 放置 cSEMS 后观察到的 ABS 缓解率似乎与先前报告的多次 ERCP 联合塑料支架放置的缓解率相当。支架插入时间较长与 ABS 缓解的可能性增加相关。
