Sa1294 PLASTIC BILIARY STENT PLACEMENT IS NON-INFERIOR TO METAL STENTS IN LONG-TERM MANAGEMENT OF REFRACTORY POST-LIVER TRANSPLANT ANASTOMOTIC STRICTURES

Abstract

Anastomotic strictures occur in 5%-15% of deceased donor liver transplants and in up to 32% of live donor transplants. Endoscopic therapy includes balloon dilation and stenting, either via multiple plastic stents or use of self-expanding metal stents (SEMS). Recurrence rates after an initially-successful endoscopic treatment has been reported between 18-34% at one year follow-up. Very little literature is available on the long-term prognosis. Our aim was to describe the long-term success rate of plastic and SEMS in the management of post-transplant refractory anastomotic strictures. A retrospective analysis of consecutive patients undergoing endoscopic stent placement for refractory anastomotic strictures in a post-liver transplant population from 2010 to 2017 was conducted. Their age at first intervention, sex (percent male), reason for liver transplantion and number of ERCPs were collected. Patients were then separated by first SEMS indwelling time of <6 months or ≥6 months and by type of initial stent placed (SEMS vs. plastic). The mean number of ERCPs after the 1st SEMS was placed were compared in the 6 month indwelling time, and type of initial stent (SEMS vs. plastic) groups using student’s t-test. 31 patients were identified. Their mean age at intervention (first SEMS) is 53 years (range 36-74), and 74% (23) were males. The most common reasons for liver transplantation were combinations including non-alcoholic steatohepatitis n=6 (19%), alcoholic cirrhosis n=6 (19%), hepatocellular carcinoma n=6 (19%), primary biliary cholangitis n=4 (13%), primary sclerosing cholangitis n=3 (10%) and others. The mean number of total ERCPs was 6.7 ± 5.2, with a mean number of 4.3 ±3.5 ERCPs after 1st SEMS. Overall, 13 (42%) patients went straight to SEMS placement, and 18 (58.1%) had previously-placed plastic stents. Average follow up was 1283 days (range: 118-2641 days). Statistical analysis showed a trend toward no difference in the mean number of ERCPs required between patients who received SEMS versus plastic stents at their first procedure (4.1 ± 4.2 vs. 4.4 ± 3; p=0.7). There was also a trend towards no difference in the mean number of ERCP when SEMS were left in place more than 6 months versus for shorter periods of time (3.7 ± 3.1 vs 4.6 ± 3.6 ; p=0.55).Acute procedural adverse events included: pancreatitis n=4 (13%), post-ERCP abdominal pain n=3 (10%), bleeding n=2 (6.5%) and perforation n=1 (3%). Delayed procedure-related adverse events were cholangitis n=9 (29%), stricture development n=6 (19%), stenosis n=5 (16%) and stent migration n=9 (56%). Success of endoscopic stenting for refractory anastomotic strictures in post-liver transplant patients does not appear to be affected by various stenting paradigms in the long term. Specifically, SEMS are no better than plastic stents in this unique patient population.