Safety and efficacy of Kaffes intraductal self-expanding metal stents in the management of post-liver transplant anastomotic strictures  

作　　者：Chee Lim Jonathan Ng Babak Sarraf Rhys Vaughan Marios Efthymiou Leonardo Zorron Cheng Tao Pu Sujievvan Chandran 

机构地区：[1]Department of Gastroenterology and Hepatology,Austin Health,Melbourne Heidelberg,VIC 3084,Australia [2]Melbourne Medical School,The University of Melbourne,Melbourne Parkville,VIC 3052,Australia

出　　处：《World Journal of Transplantation》2024年第2期88-98,共11页世界移植杂志

摘　　要：BACKGROUND Endoscopic management is the first-line therapy for post-liver-transplant anas-tomotic strictures.Although the optimal duration of treatment with plastic stents has been reported to be 8-12 months,data on safety and duration for metal stents in this setting is scarce.Due to limited access to endoscopic retrograde cholan-giopancreatography(ERCP)during the coronavirus disease 2019 pandemic in our centre,there was a change in practice towards increased usage and length-of-stay of the Kaffes biliary intraductal self-expanding stent in patients with suitable anatomy.This was mainly due to the theoretical benefit of Kaffes stents allowing for longer indwelling periods compared to the traditional plastic stents.METHODS 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.RESULTS 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,perfor-ations 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

关 键 词：Liver transplantation CHOLANGIOPANCREATOGRAPHY Endoscopic retrograde CONSTRICTION PATHOLOGIC Self expandable metallic stents Bile duct diseases CHOLESTASIS 

分 类 号：R726.9[医药卫生—儿科]