Self-expanding Metal Stents (SEMS) Does Not Offer Benefit Over Multiple Plastic Stents (MPS) for Post-Liver Transplant Anastomotic Biliary Strictures: A Systematic Review and Meta-Analysis

Abstract

Introduction: Liver transplant course is often complicated by anastomotic biliary strictures requiring early intervention and stent placement to preserve graft function. Multiple plastic stents (MPS) are routinely used however their comparative efficacy against self-expanding metal stents (SEMS) is not known. Our aim was to perform systematic review and meta-analysis to compare SEMS vs MPS for post-liver transplant anastomotic biliary strictures. Methods: Following electronic databases were used for literature search: Pubmed, embase, google scholar and Cochrane review. Studies comparing SEMS and MPS for post liver transplant anastomotic biliary strictures only were included. Benign biliary stricture other than post-transplant and suspicious malignant stricture causing obstruction were excluded. Pooled rates of stricture resolution, stricture recurrence and pancreatitis rates were compared for SEMS vs MPS. Outcomes were reported as pooled odds ratio (OR) with 95% confidence intervals (CI) with statistical significance (p Results: Four eligible studies were found with 146 patients undergoing SEMS placement (average follow up: 19.2 month) vs 207 undergoing MPS placement (average follow up 19.7 months). Median of 2 ERCP were required in SEMS while 4-4.5 ERCPs were required in SEMS group. Pooled rate of stricture resolution for SEMS vs MPS: 88% vs 93%, pooled OR 0.57, 95% CI 0.28-1.18, I2 51%, p 0.13. SEMS has statistically significant higher rate of stricture recurrence compared to MPS (26% vs 7.3%) with pooled OR 3.89, 95%CI 2.03-7.44, p < 0.01. There was higher rate of pancreatitis with SEMS compared to MPS (13% vs 3.3%, pooled OR 4.22, 95% CI 1.62-10.99, p < 0.01). Conclusion: This meta-analysis of available literature shows that SEMS does not offer benefit over MPS for post-liver transplant anastomotic biliary strictures.Figure: STRICTURE RESOLUTION.Figure: STRICTURE RECURRENCE.