Published online Jun 18, 2024. doi: 10.5500/wjt.v14.i2.91081
Revised: March 8, 2024
Accepted: March 25, 2024
Published online: June 18, 2024
Processing time: 175 Days and 22.5 Hours
Endoscopic management is the first-line therapy for post-liver-transplant anas
To compare the safety and efficacy profile of different stenting durations using Kaffes stents.
Adult liver transplant recipients aged 18 years and above who underwent ERCP were retrospectively identified during a 10-year period through a database query. Unplanned admissions post-Kaffes stent insertion were identified manually through electronic and scanned medical records. The main outcome was the incidence of complications when stents were left indwelling for 3 months vs 6 months. Stent efficacy was calculated via rates of stricture recurrence between patients that had stenting courses for ≤ 120 d or > 120 d.
During the study period, a total of 66 ERCPs with Kaffes insertion were performed in 54 patients throughout their stenting course. In 33 ERCPs, the stent was removed or exchanged on a 3-month interval. No pancreatitis, perforations or deaths occurred. Minor post-ERCP complications were similar between the 3-month (abdominal pain and intraductal migration) and 6-month (abdominal pain, septic shower and embedded stent) groups - 6.1% vs 9.1% respectively, P = 0.40. All strictures resolved at the end of the stenting course, but the stenting course was variable from 3 to 22 months. The recurrence rate for stenting courses lasting for up to 120 d was 71.4% and 21.4% for stenting courses of 121 d or over (P = 0.03). There were 28 patients that were treated with a single ERCP with Kaffes, 21 with removal after 120 d and 7 within 120 d. There was a significant improvement in stricture recurrence when the Kaffes was removed after 120 d when a single ERCP was used for the entire stenting course (71.0% vs 10.0%, P = 0.01).
Utilising a single Kaffes intraductal fully-covered metal stent for at least 4 months is safe and efficacious for the management of post-transplant anastomotic strictures.
Core Tip: Biliary strictures are the most common complication post orthotopic liver transplantation. This retrospective study evaluates the safety and efficacy of managing such strictures using intraductal fully-covered metal stent (Kaffes) for different durations. The results show that a single Kaffes stent indwelling for at least 4 months is safe and effective for treating post liver transplant anastomotic strictures.