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Endoscopic Management of Biliary Strictures after Orthotopic Liver Transplantation: A Single Center Experience Study
Background and Aim. Endoscopic therapy is the method of choice in the management of biliary strictures after orthotopic liver transplantation (OLT). Even though the mainstay approach for OLT stricture complications is represented by consecutive procedures of multiple plastic stents (MPS) insertion,...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9140460/ https://www.ncbi.nlm.nih.gov/pubmed/35626376 http://dx.doi.org/10.3390/diagnostics12051221 |
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author | Sandru, Vasile Stan-Ilie, Madalina Plotogea, Oana-Mihaela Vladut, Catalina Ungureanu, Bogdan Silviu Balan, Gheorghe G. Gheonea, Dan Ionut Constantinescu, Gabriel |
author_facet | Sandru, Vasile Stan-Ilie, Madalina Plotogea, Oana-Mihaela Vladut, Catalina Ungureanu, Bogdan Silviu Balan, Gheorghe G. Gheonea, Dan Ionut Constantinescu, Gabriel |
author_sort | Sandru, Vasile |
collection | PubMed |
description | Background and Aim. Endoscopic therapy is the method of choice in the management of biliary strictures after orthotopic liver transplantation (OLT). Even though the mainstay approach for OLT stricture complications is represented by consecutive procedures of multiple plastic stents (MPS) insertion, a valuable alternative is the use of fully covered self-expandable metal stents (FCSEMS). The aim of the study was to compare MPS with FCSEMS used in the management of OLT biliary strictures, in terms of clinical outcomes and complications. Material and Methods. This is a retrospective, single-center study conducted between February 2014 and November 2019 in the Clinical Emergency Hospital of Bucharest, Romania. We enrolled all consecutive patients who developed biliary strictures after OLT and were treated by endoscopic retrograde cholangiopancreatography (ERCP) either with MPS or FCSEMS. Results. Thirty-six patients were included in the study, 27 patients had MPS and nine patients had FCSEMS. 106 ERCP procedures were performed and 159 stents were inserted. The mean number of ERCP procedures required per patient was significantly higher for MPS than for FCSEMS (3.34 ± 1.46 vs. 2.11 ± 0.33, p < 0.001). In the FCSEMS group only one patient had three procedures, due to stent migration. Difficult cannulation was encountered in 22 patients, 18 patients from MPS group and four patients from FCSEMS group. Dilation was performed in 20 (77%) MPS patients and in four FCSEMS patients (44%). Overall, we used 159 stents for stricture resolution, 149 plastic stents and 10 FCSEMS. Mean number of stents inserted was significantly lower in the FCSEMS group compared to MPS group (1.16 ± 0.40 vs. 5.73 ± 2.64, p < 0.001). Conclusions. Stricture resolution using FCSEMS is comparable to MPS and even has some advantages. In line with prior studies, FCSEMS are effective, with fewer complications and similar outcome compared to plastic stents. Other particular aspects should be further assessed, especially long-term follow up of FCSEMS and their cost efficiency. |
format | Online Article Text |
id | pubmed-9140460 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-91404602022-05-28 Endoscopic Management of Biliary Strictures after Orthotopic Liver Transplantation: A Single Center Experience Study Sandru, Vasile Stan-Ilie, Madalina Plotogea, Oana-Mihaela Vladut, Catalina Ungureanu, Bogdan Silviu Balan, Gheorghe G. Gheonea, Dan Ionut Constantinescu, Gabriel Diagnostics (Basel) Article Background and Aim. Endoscopic therapy is the method of choice in the management of biliary strictures after orthotopic liver transplantation (OLT). Even though the mainstay approach for OLT stricture complications is represented by consecutive procedures of multiple plastic stents (MPS) insertion, a valuable alternative is the use of fully covered self-expandable metal stents (FCSEMS). The aim of the study was to compare MPS with FCSEMS used in the management of OLT biliary strictures, in terms of clinical outcomes and complications. Material and Methods. This is a retrospective, single-center study conducted between February 2014 and November 2019 in the Clinical Emergency Hospital of Bucharest, Romania. We enrolled all consecutive patients who developed biliary strictures after OLT and were treated by endoscopic retrograde cholangiopancreatography (ERCP) either with MPS or FCSEMS. Results. Thirty-six patients were included in the study, 27 patients had MPS and nine patients had FCSEMS. 106 ERCP procedures were performed and 159 stents were inserted. The mean number of ERCP procedures required per patient was significantly higher for MPS than for FCSEMS (3.34 ± 1.46 vs. 2.11 ± 0.33, p < 0.001). In the FCSEMS group only one patient had three procedures, due to stent migration. Difficult cannulation was encountered in 22 patients, 18 patients from MPS group and four patients from FCSEMS group. Dilation was performed in 20 (77%) MPS patients and in four FCSEMS patients (44%). Overall, we used 159 stents for stricture resolution, 149 plastic stents and 10 FCSEMS. Mean number of stents inserted was significantly lower in the FCSEMS group compared to MPS group (1.16 ± 0.40 vs. 5.73 ± 2.64, p < 0.001). Conclusions. Stricture resolution using FCSEMS is comparable to MPS and even has some advantages. In line with prior studies, FCSEMS are effective, with fewer complications and similar outcome compared to plastic stents. Other particular aspects should be further assessed, especially long-term follow up of FCSEMS and their cost efficiency. MDPI 2022-05-13 /pmc/articles/PMC9140460/ /pubmed/35626376 http://dx.doi.org/10.3390/diagnostics12051221 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Sandru, Vasile Stan-Ilie, Madalina Plotogea, Oana-Mihaela Vladut, Catalina Ungureanu, Bogdan Silviu Balan, Gheorghe G. Gheonea, Dan Ionut Constantinescu, Gabriel Endoscopic Management of Biliary Strictures after Orthotopic Liver Transplantation: A Single Center Experience Study |
title | Endoscopic Management of Biliary Strictures after Orthotopic Liver Transplantation: A Single Center Experience Study |
title_full | Endoscopic Management of Biliary Strictures after Orthotopic Liver Transplantation: A Single Center Experience Study |
title_fullStr | Endoscopic Management of Biliary Strictures after Orthotopic Liver Transplantation: A Single Center Experience Study |
title_full_unstemmed | Endoscopic Management of Biliary Strictures after Orthotopic Liver Transplantation: A Single Center Experience Study |
title_short | Endoscopic Management of Biliary Strictures after Orthotopic Liver Transplantation: A Single Center Experience Study |
title_sort | endoscopic management of biliary strictures after orthotopic liver transplantation: a single center experience study |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9140460/ https://www.ncbi.nlm.nih.gov/pubmed/35626376 http://dx.doi.org/10.3390/diagnostics12051221 |
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