OBJECTIVE: To compare the safety and efficacy profile of different stenting durations using Kaffes 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, perforations 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 d and 7 within 120 d. There was a significant improvement in stricture recurrence when the Kaffes was removed after 120 d when a single ERCP was used for the entire stenting course (71.0% vs 10.0%, P = 0.01).
CONCLUSIONS: Utilising a single Kaffes intraductal fully-covered metal stent for at least 4 months is safe and efficacious for the management of post-transplant anastomotic strictures.
目的:比较使用Kaffes支架的不同支架置入持续时间的安全性和有效性。
方法:在10年期间通过数据库查询对18岁及以上接受ERCP的成人肝移植受者进行回顾性鉴定。通过电子和扫描的医疗记录手动识别Kaffes支架插入后的计划外入院。主要结果是支架留置3个月和6个月时的并发症发生率。通过支架置入疗程≤120d或>120d的患者狭窄复发率计算支架疗效。
结果:在研究期间,在54例患者的整个支架置入过程中,共进行了66例ERCPs和Kaffes置入.在33个ERCP中,每隔3个月取出或更换支架.没有胰腺炎,穿孔或死亡发生。在3个月(腹痛和导管内迁移)和6个月(腹痛,化粪池淋浴和嵌入式支架)组-分别为6.1%和9.1%,P=0.40。所有狭窄都在支架置入过程结束时解决,但支架置入过程在3~22个月不等.支架置入过程持续120d的复发率为71.4%,支架置入过程持续121d或以上的复发率为21.4%(P=0.03)。有28例患者接受了Kaffes的单一ERCP治疗,在120d后取出21例,在120d内取出7例。当在整个支架置入过程中使用单一ERCP时,在120d后取出Kaffes时,狭窄的复发显着改善(71.0%vs10.0%,P=0.01)。
结论:使用单个Kaffes导管内完全覆盖的金属支架至少4个月对于处理移植后吻合口狭窄是安全有效的。