肝移植术后吻合口狭窄治疗中使用的完全覆盖式胆管内自膨式金属支架：一项全英国范围的经验。
Intraductal fully covered self-expanding metal stents in the management of post-liver transplant anastomotic strictures: a UK wide experience.
作者信息
Ahmed Wafaa, Kyle Dave, Khanna Amardeep, Devlin John, Reffitt David, Zeino Zeino, Webster George, Phillpotts Simon, Gordon Robert, Corbett Gareth, Gelson William, Nayar Manu, Khan Haider, Cramp Matthew, Potts Jonathan, Fateen Waleed, Miller Hamish, Paranandi Bharat, Huggett Matthew, Everett Simon M, Hegade Vinod S, O'Kane Rebecca, Scott Ryan, McDougall Neil, Harrison Phillip, Joshi Deepak
机构信息
Institute for Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK.
Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK.
出版信息
Therap Adv Gastroenterol. 2022 Sep 26;15:17562848221122473. doi: 10.1177/17562848221122473. eCollection 2022.
BACKGROUND
Fully covered intraductal self-expanding metal stents (IDSEMS) have been well described in the management of post-liver transplant (LT) anastomotic strictures (ASs). Their antimigration waists and intraductal nature make them suited for deployment across the biliary anastomosis.
OBJECTIVES
We conducted a multicentre study to analyse their use and efficacy in the management of AS.
DESIGN
This was a retrospective, multicentre observational study across nine tertiary centres in the United Kingdom.
METHODS
Consecutive patients who underwent endoscopic retrograde cholangiopancreatography with IDSEMS insertion were analysed retrospectively. Recorded variables included patient demographics, procedural characteristics, response to therapy and follow-up data.
RESULTS
In all, 162 patients (100 males, 62%) underwent 176 episodes of IDSEMS insertion for AS. Aetiology of liver disease in this cohort included hepatocellular carcinoma ( = 35, 22%), followed by alcohol-related liver disease ( = 29, 18%), non-alcoholic steatohepatitis ( = 20, 12%), primary biliary cholangitis ( = 15, 9%), acute liver failure ( = 13, 8%), viral hepatitis ( = 13, 8%) and autoimmune hepatitis ( = 12, 7%). Early AS occurred in 25 (15%) cases, delayed in 32 (20%) cases and late in 95 (59%) cases. Age at transplant was 54 years (range, 12-74), and stent duration was 15 weeks (range, 3 days-78 weeks). In total, 131 (81%) had complete resolution of stricture at endoscopic re-evaluation. Stricture recurrence was observed in 13 (10%) cases, with a median of 19 weeks (range, 4-88 weeks) after stent removal. At removal, there were 21 (12%) adverse events, 5 (3%) episodes of cholangitis and 2 (1%) of pancreatitis. In 11 (6%) cases, the removal wires unravelled, and 3 (2%) stents migrated. All were removed endoscopically.
CONCLUSION
IDSEMS appears to be safe and highly efficacious in the management of post-LT AS, with low rates of AS recurrence.
背景
全覆膜自膨式金属支架（IDSEMS）在肝移植（LT）术后吻合口狭窄（AS）的治疗中已有详细描述。其防迁移腰部和管内性质使其适合在胆管吻合口处放置。
目的
我们进行了一项多中心研究，以分析其在AS治疗中的应用和疗效。
设计
这是一项在英国九个三级中心进行的回顾性多中心观察性研究。
方法
对连续接受内镜逆行胰胆管造影并插入IDSEMS的患者进行回顾性分析。记录的变量包括患者人口统计学、手术特征、治疗反应和随访数据。
结果
共有162例患者（100例男性，62%）因AS接受了176次IDSEMS插入术。该队列中肝病的病因包括肝细胞癌（35例，22%），其次是酒精性肝病（29例，18%）、非酒精性脂肪性肝炎（20例，12%）、原发性胆汁性胆管炎（15例，9%）、急性肝衰竭（13例，8%）、病毒性肝炎（13例，8%）和自身免疫性肝炎（12例，7%）。早期AS发生在25例（15%），延迟发生在32例（20%），晚期发生在95例（59%）。移植时年龄为54岁（范围12 - 74岁），支架置入时间为15周（范围3天 - 78周）。在内镜复查时，共有131例（81%）患者狭窄完全缓解。13例（10%）患者观察到狭窄复发，支架取出后中位复发时间为第周（范围4 - 88周）。取出时，有21例（12%）发生不良事件，5例（3%）发生胆管炎，2例（1%）发生胰腺炎。11例（6%）患者取出钢丝散开，3例（2%）支架移位。所有均通过内镜取出。
结论
IDSEMS在LT术后AS的治疗中似乎安全且高效，AS复发率低。
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