Baraldo Stefano, Meine Gilmara Coelho, Santo Paula Arruda Espirito, Barbosa Eduardo Cerchi, Nau Angélica Luciana, Keane Margaret G, Chavan Radhika, Kuo Yu-Ting, Ligresti Dario
Department of Endoscopy, Barretos Cancer Hospital, R. Antenor Duarte Vilela, 1331 - Dr. Paulo Prata, Barretos, Sao Paulo, 14784 400, Brazil.
Division of Gastroenterology, Department of Internal Medicine, Feevale University, Novo Hamburgo, Brazil.
Surg Endosc. 2025 Feb;39(2):721-729. doi: 10.1007/s00464-024-11467-6. Epub 2024 Dec 19.
The most common adverse event (AE) of orthotopic liver transplantation (OLT) is anastomotic biliary stricture (ABS). Management varies widely between centers, and it is not clear whether a combination of endoscopic dilation of the stenosis followed by multiple plastic stents (MPS) or placement of a fully covered self-expandable metal stent (fcSEMS) is better for the management of post-OLT ABS. This systematic review and meta-analysis aimed to compare the efficacy, safety, and cost of fcSEMS versus MPS in the treatment of post-OLT ABS.
We searched PubMed, Cochrane, and Embase databases for randomized controlled trials (RCTs) comparing fcSEMS with MPS for the treatment of patients with post-OLT ABS and reporting at least one of the outcomes of interest. The pooled estimates were calculated using the random-effects model, and I statistics were used to evaluate heterogeneity.
The study included 5 RCTs (245 patients). There was no statistically significant difference between fcSEMS and MPS in stricture resolution (RR 0.99; 95% CI 0.88 to 1.11; p = 0.86), stricture recurrence (RR 2.22; 95% CI 0.73 to 6.75; p = 0.16), treatment cost (MD - 5.31 thousand dollars 95% CI -12.76 to 2.13; p = 0.16), and AEs (RR 0.87; 95% CI 0.27 to 2.83; p = 0.82). However, fcSEMS reduced the number of ERCP sessions (MD - 1.7 sessions; CI 95% - 2.9 to - 0.5; p = 0.005) and treatment duration (MD-95.7 days; 95% CI -184.5 to -6.9; p = 0.03) compared with MPS.
fcSEMS and MPS had similar efficacy and safety in patients with ABS post-OLT. However, fcSEMS was associated with fewer ERCP sessions and shorter treatment duration.
原位肝移植（OLT）最常见的不良事件（AE）是吻合口胆管狭窄（ABS）。各中心的治疗方法差异很大，目前尚不清楚狭窄内镜扩张后联合多个塑料支架（MPS）或置入全覆膜自膨式金属支架（fcSEMS）哪种方法更适合OLT术后ABS的治疗。本系统评价和荟萃分析旨在比较fcSEMS与MPS治疗OLT术后ABS的疗效、安全性和成本。
我们检索了PubMed、Cochrane和Embase数据库，查找比较fcSEMS与MPS治疗OLT术后ABS患者并报告至少一项感兴趣结局的随机对照试验（RCT）。采用随机效应模型计算合并估计值，并用I统计量评估异质性。
该研究纳入了5项RCT（245例患者）。fcSEMS与MPS在狭窄缓解（RR 0.99；95%CI 0.88至1.11；p = 0.86）、狭窄复发（RR 2.22；95%CI 0.73至6.75；p = 0.16）、治疗成本（MD - 5310美元；95%CI -12760至2130；p = 0.16）和不良事件（RR 0.87；95%CI 0.27至2.83；p = 0.82）方面无统计学显著差异。然而与MPS相比，fcSEMS减少了内镜逆行胰胆管造影（ERCP）的次数（MD - 1.7次；95%CI - 2.9至 - 0.5；p = 0.005）和治疗持续时间（MD - 95.7天；95%CI -184.5至 - 6.9；p = 0.03）。
fcSEMS与MPS在OLT术后ABS患者中具有相似的疗效和安全性。然而，fcSEMS与较少的ERCP次数和较短的治疗持续时间相关。
