Transplant Trial Watch

Multiple Plastic Stents Versus Covered Metal Stent for Treatment of Anastomotic Biliary Strictures after Liver Transplantation: a Prospective, Randomized, Multicenter Trial.

Tal AO, Finkelmeier F, et al.

Gastrointest Endosc 2017 [record in progress].


Aims
To investigate the use of covered self-expandable metal stents (cSEMSs) compared to multiple plastic stents (MPSs) for the treatment of anastomotic biliary strictures (ABSs) after orthotopic liver transplantation (OLT).

Interventions
Participants were randomized to receive either MPSs or cSEMSs.

Participants
58 patients who underwent deceased donor OLT for end−stage liver disease or acute liver failure with confirmed ABS.

Outcomes
The primary outcome measured was the number of endoscopic interventions until ABS resolution. Secondary outcomes measured were frequency of adverse events, treatment success rates, time to treatment success and recurrence of ABS during follow-up.

Follow-up
1 year

CET Conclusions
Anastomotic biliary strictures are a major cause of morbidity after orthotropic liver transplantation and occur in around 15% of recipients. These are managed non-surgically and in general involve the insertion endoscopically or percutaneously of plastic stents usually on several occasions. In general four to five interventions are required until the stricture is dilated sufficiently. In this study from four centres (Helsinki, Essen, Frankfurt and Milan), 58 patients with anastomotic biliary structure were randomised to be treated either with multiple plastic stents or covered self-expandable metal stents and 48 completed follow up. Fewer endoscopic interventions were required with metal stents and fewer metal stents than plastic stents were required till resolution of the stricture. However, migration of the metal stents occurred in 33% of patients. The authors do point out that there are several coated metal stents available and in this trial use was not limited to one single pilot stent and so it is possible that some may be superior to others. As improvement in the coated metal stents occurs this should decrease the migration rates of these stents but the optimal duration of this type of therapy, and the cost efficacy of the metal stents versus the multiple plastic stents, require further investigation.

Jadad score
3

Data analysis
Modified intention-to-treat analysis

Allocation concealment
No

Trial registration
ClinicalTrials.gov - NCT01393067

Funding source
No funding received