Endoscopic approach for management of biliary strictures in liver transplant recipients: A systematic review and meta-analysis.
Aparicio D, Otoch JP, et al.United European Gastroenterology Journal 2017; 5(6): 827-845
Aims
To conduct a systematic review and meta-analysis to compare different endoscopic techniques to treat post-liver transplantation biliary strictures.
Interventions
The databases Medline, PubMed, Scielo-LILACS, Embase, and the Cochrane Library were searched until June 2015 for all randomized, non-randomized and prospective, retrospective cohort studies for the endoscopic treatment of post-liver transplant biliary strictures. Two reviewers independently searched the databases and reviewed studies for inclusion. Disagreements were discussed with a third reviewer and agreement was reached by consensus.
Participants
7 clinical trials (one randomized and six not randomized) and 32 cohort studies were included.
Outcomes
Measured outcomes included stricture incidence, resolution and recurrence, endoscopic treatment complications and technical failure, stenosis recurrence, treatment failure and use of plastic stent versus self-expandable metal stent.
Follow-up
Not described
CET Conclusions
This systematic review aimed to compare endoscopic techniques to treat biliary strictures after liver transplantation. The review was registered with PROSPERO and included studies that evaluated endoscopic treatments for anastomotic or non-anastomotic strictures for living (LD) or deceased donor (DD) liver transplantation. Medline, EMBASE, LILACS and the Cochrane Library were searched and two reviewers independently screened the search results. One RCT, six non-random comparative clinical trials (non-RCT) and 32 cohort studies were included. It was unclear whether data extraction and quality assessment was done by 2 independent reviewers. The RCT and non-RCTs were assessed for quality using the Jadad scale and the Newcastle-Ottawa scale but only total scores were presented. No table was provided with characteristics of all included studies. Pooling data across the non-RCTs showed that the incidence of strictures was less in DD liver transplantation compared to LD liver transplantation. Meta-analyses of outcomes of several endoscopic treatments showed no differences but all meta-analyses only included 2 studies and most showed significant heterogeneity.
Quality notes
Quality assessment not appropriate
Trial registration
PROSPERO—CRD42016033010