TREATMENT OF BILIARY STRICTURES AFTER ORTHOTOPIC LIVER TRANSPLANTATION – A COMPARISON BETWEEN SELF-EXPANDABLE METAL STENTS AND PLASTIC STENTS

Aims:

To assess the stricture resolution in orthotopic liver transplantation (OLT) patients by ERCP stent placement in a tertiary care hospital.

Methods:

This is a retrospective study which enrolled patients from January 2013 to September 2017 with OLT anastomotic strictures and the ERCP procedures. The set-up included two groups, according to the type of stent used, either plastic (PS) or covered self expandable metal stents (SEMS) with their outcomes. We assessed the number of ERCP per pacient, the number of stents used, early post ERCP complications.

Results:

The study included 28 patients diagnosed with anastomotic billiary stricture post OLT. A total of 86 ERCP procedures were performed, with an overall mean of 2.86 per patient. 17 patients had plastic stents inserted, while 9 had SEMS. There were 2 patients with failed ERCP in wich the stricture was to tight or to complex. Patients required in average 3.06 PS and 1.44 SEMS (p < 0.05). The SEMS group (9 patients) had a lower procedure time and also fewer interventions were performed than the PS group (1.89 vs. 3.53, p < 0.05). The most common complication was acute pancreatitis which occured in 11% of all ERCP procedures, and it was significantly more encoutered in patients with SEMS (p < 0.05). One patient died with massive hemobilia after plastic stent placement.

Conclusions:

Patients with PS required a larger number of ERCP procedures and a mean of 3 stents per patient, which translates in higher costs for each patient; in comparison, the SEMS group needed less procedures and on average only 1.44 metal stents until resolution of the strictures.

From our experience, SEMS, when technical possible, seems the best choice of treatment and the most cost-efficient way to solve biliary strictures after OLT.