Abstract：
OBJECTIVE: Endoscopic multiple plastic stents are an established first-line treatment for anastomotic biliary stricture (ABS) management after liver transplantation (LT). Fully covered self-expandable metallic stents (FCSEMSs) have recently been used with favorable outcomes, but long-term treatment outcomes remain an issue for ABS. We evaluated the long-term outcomes of FCSEMS for the management of refractory ABS after LT.
METHODS: We reviewed the prospectively collected and maintained endoscopic retrograde cholangiography database at Asan Medical Center to retrieve consecutive post-LT ABS cases that underwent an endoscopic FCSEMS placement between August 2009 and August 2019 after MPS placement failure.
RESULTS: A total of 34 patients were enrolled in this study. Technical success had been achieved in all subjects (100%). The median stent placement duration was 3.1 months (IQR 2.7-6.1). Stricture resolution was achieved in 26 patients (clinical success 76.5%, 95% confidence interval 62-91). Early adverse events developed in 3 patients (8.8%), including distal stent migration. Late adverse events occurred in 9 patients (26.5%), including cholangitis (n = 7, 20.6%) and asymptomatic distal stent migration (n = 2, 5.9%). The median follow-up period was 57.9 months (IQR 51.9-64.3). Stricture recurrence occurred in 3 of 26 patients who achieved clinical success (11.5%).
CONCLUSIONS: FCSEMS placement appears to be an effective and advisable intervention for refractory ABS as it can provide persistent stricture improvement over the long-term.
METHODS: We reviewed the prospectively collected and maintained endoscopic retrograde cholangiography database at Asan Medical Center to retrieve consecutive post-LT ABS cases that underwent an endoscopic FCSEMS placement between August 2009 and August 2019 after MPS placement failure.
RESULTS: A total of 34 patients were enrolled in this study. Technical success had been achieved in all subjects (100%). The median stent placement duration was 3.1 months (IQR 2.7-6.1). Stricture resolution was achieved in 26 patients (clinical success 76.5%, 95% confidence interval 62-91). Early adverse events developed in 3 patients (8.8%), including distal stent migration. Late adverse events occurred in 9 patients (26.5%), including cholangitis (n = 7, 20.6%) and asymptomatic distal stent migration (n = 2, 5.9%). The median follow-up period was 57.9 months (IQR 51.9-64.3). Stricture recurrence occurred in 3 of 26 patients who achieved clinical success (11.5%).
CONCLUSIONS: FCSEMS placement appears to be an effective and advisable intervention for refractory ABS as it can provide persistent stricture improvement over the long-term.
摘要：
目的：内镜下多层塑料支架是肝移植（LT）后吻合口胆管狭窄（ABS）的一线治疗方法。完全覆盖的自膨胀金属支架（FCSEMS）最近已被用于有利的结果，但长期治疗结果仍然是ABS的一个问题.我们评估了FCSEMS对LT术后难治性ABS的长期治疗效果。
方法：我们回顾了在Asan医学中心前瞻性收集和维护的内镜逆行胆道造影数据库，以检索在2009年8月至2019年8月期间在MPS放置失败后接受内镜FCSEMS放置的连续LT后ABS病例。
结果：本研究共纳入34例患者。所有科目都取得了技术成功(100%)。中位支架置入时间为3.1个月(IQR2.7-6.1)。26例患者获得了狭窄解决（临床成功率为76.5％，95%置信区间62-91)。3例患者出现早期不良事件（8.8%），包括远端支架迁移。9例患者（26.5%）发生晚期不良事件，包括胆管炎（n=7，20.6%）和无症状的远端支架移位（n=2，5.9%）。中位随访期为57.9个月(IQR51.9-64.3)。26例临床成功患者中有3例发生狭窄复发（11.5%）。
结论：FCSEMS放置似乎是难治性ABS的有效和明智的干预措施，因为它可以长期提供持续的狭窄改善。
方法：我们回顾了在Asan医学中心前瞻性收集和维护的内镜逆行胆道造影数据库，以检索在2009年8月至2019年8月期间在MPS放置失败后接受内镜FCSEMS放置的连续LT后ABS病例。
结果：本研究共纳入34例患者。所有科目都取得了技术成功(100%)。中位支架置入时间为3.1个月(IQR2.7-6.1)。26例患者获得了狭窄解决（临床成功率为76.5％，95%置信区间62-91)。3例患者出现早期不良事件（8.8%），包括远端支架迁移。9例患者（26.5%）发生晚期不良事件，包括胆管炎（n=7，20.6%）和无症状的远端支架移位（n=2，5.9%）。中位随访期为57.9个月(IQR51.9-64.3)。26例临床成功患者中有3例发生狭窄复发（11.5%）。
结论：FCSEMS放置似乎是难治性ABS的有效和明智的干预措施，因为它可以长期提供持续的狭窄改善。
