Multiple plastic versus fully covered metal stents for managing post-liver transplantation anastomotic biliary strictures: a metaanalysis of randomized controlled trials

Alberto Tringali; Ilaria Tarantino; Luca Barresi; Mario Traina; Giulia Bonato; Marcello Cintolo; Cesare Hassan; Massimiliano Mutignani; Douglas G. Adler

Authors Alberto Tringali, Ilaria Tarantino, Luca Barresi, Mario Traina, Giulia Bonato, Marcello Cintolo, Cesare Hassan, Massimiliano Mutignani, Douglas G. Adler.

Abstract

Background Anastomotic biliary strictures (ABS) following liver transplantation (LT) are one of the most common complications, occurring in 4.5-32% of patients. Multiple plastic stenting (MPS) requires multiple sessions, with the associated risk, cost and patient discomfort. Fully covered selfexpandable metal stents (FC-SEMS) have increasingly been used in this setting. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs), comparing the role of FC-SEMS and MPS in the treatment of ABS post-LT.

Methods We conducted a bibliographic search using PubMed and EMBASE, aimed at identifying available RCTs that compared MPS to FC-SEMS in patients with ABS post LT from January 2000 to October 2017. Primary outcomes were ABS resolution and recurrence, while secondary outcomes were adverse events and number of procedures performed. Pooled estimates were calculated using random-effects models.

Results Four RCTs (205 patients) were included. ABS resolution and recurrence did not differ significantly between the groups (odds ratio [OR] 1.05, 95% confidence interval [CI] 0.43-2.56, P=0.92; and OR 2.37, 95%CI 0.54-10.38, P=0.25). The same was true for adverse events (OR 0.91, 95%CI 0.84-3.48, P=0.86) and migration rate (OR 1.31, 95%CI 0.46-3.71, P=0.61). The mean number of endoscopic retrograde cholangiopancreatography procedures was lower for FC-SEMS (mean difference [MD] -2.08).

Conclusions FC-SEMS and MPS had equal ABS resolution and recurrence, although there was a trend towards a higher recurrence rate in FC-SEMS that disappeared when trials with a shorter stent indwelling time were excluding. No difference was found in overall adverse events or migration rate.

Keywords Randomized controlled trials, meta-analysis, biliary tract disease, stent, self-expandable metal stent, plastic stent, liver transplantation, anastomotic biliary stricture

Ann Gastroenterol 2019; 32 (4): 407-415