Intraductal fully covered self-expanding metal stents in the management of post-liver transplant anastomotic strictures: a UK wide experience

Wafaa Ahmed; Dave Kyle; Amardeep Khanna; John Devlin; David Reffitt; Zeino Zeino; George Webster; Simon Phillpotts; Robert Gordon; Gareth Corbett; William Gelson; Manu Nayar; Haider Khan; Matthew Cramp; Jonathan Potts; Waleed Fateen; Hamish Miller; Bharat Paranandi; Matthew Huggett; Simon M. Everett; Vinod S. Hegade; Rebecca O’Kane; Ryan Scott; Neil McDougall; Phillip Harrison; Deepak Joshi

doi:10.1177/17562848221122473

Intraductal fully covered self-expanding metal stents in the management of post-liver transplant anastomotic strictures: a UK wide experience

Wafaa Ahmed^*, Dave Kyle, Amardeep Khanna, John Devlin, David Reffitt, Zeino Zeino, George Webster, Simon Phillpotts, Robert Gordon, Gareth Corbett, William Gelson, Manu Nayar, Haider Khan, Matthew Cramp, Jonathan Potts, Waleed Fateen, Hamish Miller, Bharat Paranandi, Matthew Huggett, Simon M. EverettVinod S. Hegade, Rebecca O’Kane, Ryan Scott, Neil McDougall, Phillip Harrison, Deepak Joshi

^*Corresponding author for this work

Peninsula Medical School

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Abstract

Background: Fully covered intraductal self-expanding metal stents (IDSEMS) have been well described in the management of post-liver transplant (LT) anastomotic strictures (ASs). Their antimigration waists and intraductal nature make them suited for deployment across the biliary anastomosis. Objectives: We conducted a multicentre study to analyse their use and efficacy in the management of AS. Design: This was a retrospective, multicentre observational study across nine tertiary centres in the United Kingdom. Methods: Consecutive patients who underwent endoscopic retrograde cholangiopancreatography with IDSEMS insertion were analysed retrospectively. Recorded variables included patient demographics, procedural characteristics, response to therapy and follow-up data. Results: In all, 162 patients (100 males, 62%) underwent 176 episodes of IDSEMS insertion for AS. Aetiology of liver disease in this cohort included hepatocellular carcinoma ( n = 35, 22%), followed by alcohol-related liver disease ( n = 29, 18%), non-alcoholic steatohepatitis ( n = 20, 12%), primary biliary cholangitis ( n = 15, 9%), acute liver failure ( n = 13, 8%), viral hepatitis ( n = 13, 8%) and autoimmune hepatitis ( n = 12, 7%). Early AS occurred in 25 (15%) cases, delayed in 32 (20%) cases and late in 95 (59%) cases. Age at transplant was 54 years (range, 12–74), and stent duration was 15 weeks (range, 3 days–78 weeks). In total, 131 (81%) had complete resolution of stricture at endoscopic re-evaluation. Stricture recurrence was observed in 13 (10%) cases, with a median of 19 weeks (range, 4–88 weeks) after stent removal. At removal, there were 21 (12%) adverse events, 5 (3%) episodes of cholangitis and 2 (1%) of pancreatitis. In 11 (6%) cases, the removal wires unravelled, and 3 (2%) stents migrated. All were removed endoscopically. Conclusion: IDSEMS appears to be safe and highly efficacious in the management of post-LT AS, with low rates of AS recurrence.

Original language	English
Number of pages	0
Journal	Therapeutic Advances in Gastroenterology
Volume	15
Issue number	0
DOIs	https://doi.org/10.1177/17562848221122473
Publication status	Published - Jan 2022

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Ahmed, W., Kyle, D., Khanna, A., Devlin, J., Reffitt, D., Zeino, Z., Webster, G., Phillpotts, S., Gordon, R., Corbett, G., Gelson, W., Nayar, M., Khan, H., Cramp, M., Potts, J., Fateen, W., Miller, H., Paranandi, B., Huggett, M., ... Joshi, D. (2022). Intraductal fully covered self-expanding metal stents in the management of post-liver transplant anastomotic strictures: a UK wide experience. Therapeutic Advances in Gastroenterology, 15(0). https://doi.org/10.1177/17562848221122473

@article{5f2b7807adb2488d9b5f6b514ad35573,

title = "Intraductal fully covered self-expanding metal stents in the management of post-liver transplant anastomotic strictures: a UK wide experience",

abstract = "Background: Fully covered intraductal self-expanding metal stents (IDSEMS) have been well described in the management of post-liver transplant (LT) anastomotic strictures (ASs). Their antimigration waists and intraductal nature make them suited for deployment across the biliary anastomosis. Objectives: We conducted a multicentre study to analyse their use and efficacy in the management of AS. Design: This was a retrospective, multicentre observational study across nine tertiary centres in the United Kingdom. Methods: Consecutive patients who underwent endoscopic retrograde cholangiopancreatography with IDSEMS insertion were analysed retrospectively. Recorded variables included patient demographics, procedural characteristics, response to therapy and follow-up data. Results: In all, 162 patients (100 males, 62%) underwent 176 episodes of IDSEMS insertion for AS. Aetiology of liver disease in this cohort included hepatocellular carcinoma ( n = 35, 22%), followed by alcohol-related liver disease ( n = 29, 18%), non-alcoholic steatohepatitis ( n = 20, 12%), primary biliary cholangitis ( n = 15, 9%), acute liver failure ( n = 13, 8%), viral hepatitis ( n = 13, 8%) and autoimmune hepatitis ( n = 12, 7%). Early AS occurred in 25 (15%) cases, delayed in 32 (20%) cases and late in 95 (59%) cases. Age at transplant was 54 years (range, 12–74), and stent duration was 15 weeks (range, 3 days–78 weeks). In total, 131 (81%) had complete resolution of stricture at endoscopic re-evaluation. Stricture recurrence was observed in 13 (10%) cases, with a median of 19 weeks (range, 4–88 weeks) after stent removal. At removal, there were 21 (12%) adverse events, 5 (3%) episodes of cholangitis and 2 (1%) of pancreatitis. In 11 (6%) cases, the removal wires unravelled, and 3 (2%) stents migrated. All were removed endoscopically. Conclusion: IDSEMS appears to be safe and highly efficacious in the management of post-LT AS, with low rates of AS recurrence. ",

author = "Wafaa Ahmed and Dave Kyle and Amardeep Khanna and John Devlin and David Reffitt and Zeino Zeino and George Webster and Simon Phillpotts and Robert Gordon and Gareth Corbett and William Gelson and Manu Nayar and Haider Khan and Matthew Cramp and Jonathan Potts and Waleed Fateen and Hamish Miller and Bharat Paranandi and Matthew Huggett and Everett, {Simon M.} and Hegade, {Vinod S.} and Rebecca O{\textquoteright}Kane and Ryan Scott and Neil McDougall and Phillip Harrison and Deepak Joshi",

year = "2022",

month = jan,

doi = "10.1177/17562848221122473",

language = "English",

volume = "15",

journal = "Therapeutic Advances in Gastroenterology",

issn = "1756-283X",

publisher = "SAGE Publications Ltd",

number = "0",

}

Ahmed, W, Kyle, D, Khanna, A, Devlin, J, Reffitt, D, Zeino, Z, Webster, G, Phillpotts, S, Gordon, R, Corbett, G, Gelson, W, Nayar, M, Khan, H, Cramp, M, Potts, J, Fateen, W, Miller, H, Paranandi, B, Huggett, M, Everett, SM, Hegade, VS, O’Kane, R, Scott, R, McDougall, N, Harrison, P & Joshi, D 2022, 'Intraductal fully covered self-expanding metal stents in the management of post-liver transplant anastomotic strictures: a UK wide experience', Therapeutic Advances in Gastroenterology, vol. 15, no. 0. https://doi.org/10.1177/17562848221122473

TY - JOUR

T1 - Intraductal fully covered self-expanding metal stents in the management of post-liver transplant anastomotic strictures: a UK wide experience

AU - Ahmed, Wafaa

AU - Kyle, Dave

AU - Khanna, Amardeep

AU - Devlin, John

AU - Reffitt, David

AU - Zeino, Zeino

AU - Webster, George

AU - Phillpotts, Simon

AU - Gordon, Robert

AU - Corbett, Gareth

AU - Gelson, William

AU - Nayar, Manu

AU - Khan, Haider

AU - Cramp, Matthew

AU - Potts, Jonathan

AU - Fateen, Waleed

AU - Miller, Hamish

AU - Paranandi, Bharat

AU - Huggett, Matthew

AU - Everett, Simon M.

AU - Hegade, Vinod S.

AU - O’Kane, Rebecca

AU - Scott, Ryan

AU - McDougall, Neil

AU - Harrison, Phillip

AU - Joshi, Deepak

PY - 2022/1

Y1 - 2022/1

N2 - Background: Fully covered intraductal self-expanding metal stents (IDSEMS) have been well described in the management of post-liver transplant (LT) anastomotic strictures (ASs). Their antimigration waists and intraductal nature make them suited for deployment across the biliary anastomosis. Objectives: We conducted a multicentre study to analyse their use and efficacy in the management of AS. Design: This was a retrospective, multicentre observational study across nine tertiary centres in the United Kingdom. Methods: Consecutive patients who underwent endoscopic retrograde cholangiopancreatography with IDSEMS insertion were analysed retrospectively. Recorded variables included patient demographics, procedural characteristics, response to therapy and follow-up data. Results: In all, 162 patients (100 males, 62%) underwent 176 episodes of IDSEMS insertion for AS. Aetiology of liver disease in this cohort included hepatocellular carcinoma ( n = 35, 22%), followed by alcohol-related liver disease ( n = 29, 18%), non-alcoholic steatohepatitis ( n = 20, 12%), primary biliary cholangitis ( n = 15, 9%), acute liver failure ( n = 13, 8%), viral hepatitis ( n = 13, 8%) and autoimmune hepatitis ( n = 12, 7%). Early AS occurred in 25 (15%) cases, delayed in 32 (20%) cases and late in 95 (59%) cases. Age at transplant was 54 years (range, 12–74), and stent duration was 15 weeks (range, 3 days–78 weeks). In total, 131 (81%) had complete resolution of stricture at endoscopic re-evaluation. Stricture recurrence was observed in 13 (10%) cases, with a median of 19 weeks (range, 4–88 weeks) after stent removal. At removal, there were 21 (12%) adverse events, 5 (3%) episodes of cholangitis and 2 (1%) of pancreatitis. In 11 (6%) cases, the removal wires unravelled, and 3 (2%) stents migrated. All were removed endoscopically. Conclusion: IDSEMS appears to be safe and highly efficacious in the management of post-LT AS, with low rates of AS recurrence.

AB - Background: Fully covered intraductal self-expanding metal stents (IDSEMS) have been well described in the management of post-liver transplant (LT) anastomotic strictures (ASs). Their antimigration waists and intraductal nature make them suited for deployment across the biliary anastomosis. Objectives: We conducted a multicentre study to analyse their use and efficacy in the management of AS. Design: This was a retrospective, multicentre observational study across nine tertiary centres in the United Kingdom. Methods: Consecutive patients who underwent endoscopic retrograde cholangiopancreatography with IDSEMS insertion were analysed retrospectively. Recorded variables included patient demographics, procedural characteristics, response to therapy and follow-up data. Results: In all, 162 patients (100 males, 62%) underwent 176 episodes of IDSEMS insertion for AS. Aetiology of liver disease in this cohort included hepatocellular carcinoma ( n = 35, 22%), followed by alcohol-related liver disease ( n = 29, 18%), non-alcoholic steatohepatitis ( n = 20, 12%), primary biliary cholangitis ( n = 15, 9%), acute liver failure ( n = 13, 8%), viral hepatitis ( n = 13, 8%) and autoimmune hepatitis ( n = 12, 7%). Early AS occurred in 25 (15%) cases, delayed in 32 (20%) cases and late in 95 (59%) cases. Age at transplant was 54 years (range, 12–74), and stent duration was 15 weeks (range, 3 days–78 weeks). In total, 131 (81%) had complete resolution of stricture at endoscopic re-evaluation. Stricture recurrence was observed in 13 (10%) cases, with a median of 19 weeks (range, 4–88 weeks) after stent removal. At removal, there were 21 (12%) adverse events, 5 (3%) episodes of cholangitis and 2 (1%) of pancreatitis. In 11 (6%) cases, the removal wires unravelled, and 3 (2%) stents migrated. All were removed endoscopically. Conclusion: IDSEMS appears to be safe and highly efficacious in the management of post-LT AS, with low rates of AS recurrence.

U2 - 10.1177/17562848221122473

DO - 10.1177/17562848221122473

M3 - Article

SN - 1756-283X

VL - 15

JO - Therapeutic Advances in Gastroenterology

JF - Therapeutic Advances in Gastroenterology

IS - 0

ER -

Intraductal fully covered self-expanding metal stents in the management of post-liver transplant anastomotic strictures: a UK wide experience

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