Covered Self-Expanding Metal Stents Versus Multiple Plastic Stents in Treating Biliary Strictures Post-Orthotopic Liver Transplantation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

OBJECTIVES

Anastomotic biliary strictures are a common complication following orthotopic liver transplantation (post-OLT), impacting morbidity and graft survival. This meta-analysis evaluates the efficacy, safety, and cost-effectiveness of covered self-expanding metal stents (cSEMS) versus multiple plastic stents (MPS) for treating post-OLT strictures.

METHODS

A systematic review was conducted in PubMed, Cochrane Central, Embase, Scholar, and SciELO. We analyzed randomized controlled trials (RCTs) comparing cSEMS and MPS in post-OLT biliary strictures. Outcomes included stricture resolution, recurrence, endoscopic retrograde cholangiopancreatography sessions, adverse events, and cost. Standardized mean differences (SMDs) and risk ratios (RRs) were calculated with 95% confidence intervals (CIs). Cost-effectiveness analysis covered direct and indirect expenses.

RESULTS

Five RCTs with 269 patients were analyzed. No significant differences were found between cSEMS and MPS in terms of stricture resolution (RR = 1.01; 95% CI [0.90, 1.13];  0.91), recurrence rates (RR = 2.23; 95% CI [0.74, 6.75];  0.15), adverse events (RR = 0.80; 95% CI [0.41, 1.54];  0.50), stent migration (RR = 1.55; 95% CI [0.69, 3.50];  0.29), number of endoscopic retrograde cholangiopancreatography sessions (SMD = -2.18; 95% CI [-5.28, 0.91];  0.12), number of stents (SMD = -2.33; 95% CI [-22.26, 17.59];  0.38), treatment time (SMD = -1.60; 95% CI [-4.24, 1.05];  0.15), and cost ($10,344 vs. $18,003;  0.19).

CONCLUSION

cSEMS and MPS demonstrate similar efficacy and safety for post-OLT biliary strictures. Both strategies are viable, with selection based on cost, anatomy, and institutional resources.