Azienda Ospedaliero Universitaria - Ospedale Civile di Baggiovara, Modena, Italy.
Liver Int. 2022 Aug;42(8):1861-1871. doi: 10.1111/liv.15246. Epub 2022 Apr 12.
The traditional endoscopic therapy of anastomotic strictures (AS) after orthotopic liver transplantation (OLT) is multiple ERCPs with the insertion of an increasing number of plastic stents side-by-side. Fully covered self-expanding metal stents (cSEMS) could be a valuable option to decrease the number of procedures needed or non-responders to plastic stents. This study aims to retrospectively analyse the results of AS endoscopic treatment by cSEMS and to identify any factors associated with its success.
Ninety-one patients (mean age 55.9 ± 7.6 SD; 73 males) from nine Italian transplantation centres, had a cSEMS positioned for post-OLT-AS between 2007 and 2017. Forty-nine (54%) patients were treated with cSEMS as a second-line treatment.
All the procedures were successfully performed without immediate complications. After ERCP, adverse events occurred in 11% of cases (2 moderate pancreatitis and 8 cholangitis). In 49 patients (54%), cSEMSs migrated. After cSEMS removal, 46 patients (51%) needed further endoscopic (45 patients) or radiological (1 patient) treatments to solve the AS. Lastly, seven patients underwent surgery. Multivariable stepwise logistic regression showed that cSEMS migration was the only factor associated with further treatments (OR 2.6, 95% CI 1.0-6.6; p value 0.03); cSEMS implantation before 12 months from OLT was associated with stent migration (OR 5.2, 95% CI 1.7-16.0; p value 0.004).
cSEMS appears to be a safe tool to treat AS. cSEMS migration is the main limitation to its routinary implantation and needs to be prevented, probably with the use of new generation anti-migration stents.
传统的经内镜吻合口狭窄（AS）治疗方法是在原位肝移植（OLT）后进行多次内镜逆行胰胆管造影（ERCP），并插入越来越多的塑料支架并排放置。全覆膜自膨式金属支架（cSEMS）可能是减少所需治疗次数或对塑料支架无反应的一种有价值的选择。本研究旨在回顾性分析 cSEMS 治疗 AS 的结果，并确定与治疗成功相关的任何因素。
来自意大利 9 个移植中心的 91 名患者（平均年龄 55.9±7.6 岁，73 名男性），于 2007 年至 2017 年间接受 cSEMS 治疗 OLT 后 AS。49 名（54%）患者将 cSEMS 作为二线治疗。
所有手术均成功完成，无即刻并发症。ERCP 后，11%的病例出现不良事件（2 例中度胰腺炎，8 例胆管炎）。在 49 名（54%）患者中，cSEMS 发生迁移。cSEMS 取出后，46 名（51%）患者需要进一步内镜（45 名）或放射学（1 名）治疗以解决 AS。最后，7 名患者接受了手术。多变量逐步逻辑回归显示，cSEMS 迁移是需要进一步治疗的唯一相关因素（OR 2.6，95%CI 1.0-6.6；p 值 0.03）；OLT 后 12 个月内植入 cSEMS 与支架迁移相关（OR 5.2，95%CI 1.7-16.0；p 值 0.004）。
cSEMS 似乎是一种安全的治疗 AS 的工具。cSEMS 迁移是其常规植入的主要限制，需要预防，可能需要使用新一代抗迁移支架。
