PDF(Pubmed)
Abstract：
BACKGROUND: Endoscopic management is the first-line therapy for post-liver-transplant anastomotic 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 cholangiopancreatography (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.
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.
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.
摘要：
背景：内镜治疗是肝移植后吻合口狭窄的一线治疗方法。尽管据报道，塑料支架治疗的最佳持续时间为8-12个月，在这种情况下，金属支架的安全性和持续时间的数据很少。由于在我们中心2019年冠状病毒疾病大流行期间，内镜逆行胰胆管造影术（ERCP）的使用有限，在具有合适解剖结构的患者中,Kaffes胆道导管内自膨式支架的使用和住院时间有所改变.这主要是由于与传统的塑料支架相比,Kaffes支架允许更长的留置期的理论益处。
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。
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。
