Scripties UMCG - Rijksuniversiteit Groningen
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Endoscopic stenting with a 3-month interval; an effective and safe treatment for anastomotic biliary strictures after liver transplantation

(2019) Brink, D. M. van den (Dorien)

Anastomotic strictures (AS) are the most encountered biliary complication after orthotopic liver transplantation (OLT)., for which endoscopic stenting is the generally accepted treatment. However, the optimal length of the interval between stent exchanges is not determined. Our aim was to compare effectiveness and safety of a short (6-8 weeks) and long (3 months) stenting interval.
All adult OLT patients who were treated with endoscopic stenting for AS were retrospectively included. Two study groups were distinguished based on the stenting interval; a short (n=27) and long (n=10) interval group. Primary outcomes were effectiveness; defined as stricture recurrence, and safety; defined as unplanned stent exchanges, due to stent occlusion or cholangitis, and adverse events. Risk factors for recurrence were examined.
Long interval stenting showed a lower recurrence rate (0%, median follow-up 25 months) than short interval stenting (42%, median follow-up 48 months). Survival analysis and a log-rank test showed a, marginally significant, lower recurrence per unit of time after long compared to short interval stenting (P=0.059). The rates of unplanned stent exchanges (15% vs 21, P=0.720) and adverse events (9% vs 10%, P=1.000) were similar between the short and long interval group. Patients with stricture recurrence had a shorter treatment (45 vs 129 days, P=0.023) and higher bilirubin (24 vs 16 U/l, P=0.008), compared to those without recurrence.
A 3-month interval between stent exchanges, for the treatment of AS after OLT, seems more effective than a shorter interval, while it does not compromise the safety of treatment.

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