Metallic vs plastic stents to treat biliary stricture after liver transplantation: a systematic review and meta-analysis based on randomized trials

• Published in: Endoscopy International Open Vol. 6; no. 8; pp. E914 - E923
• Main Authors: Visconti, Thiago Arantes de Carvalho, Bernardo, Wanderley Marques, Moura, Diogo Turiani Hourneaux, Moura, Eduardo Turiani Hourneaux, Gonçalves, Caio Vinicius Tranquillini, Farias, Galileu Ferreira, Guedes, Hugo Gonçalo, Ribeiro, Igor Braga, Franzini, Tomazo Prince, Luz, Gustavo Oliveira, dos Santos, Marcos Eduardo dos Lera, de Moura, Eduardo Guimarães Hourneaux
• Format: Journal Article
• Language: English
• Published: Stuttgart · New York Georg Thieme Verlag KG 01-08-2018
• Subjects: Review
• ISSN: 2364-3722; 2196-9736
• DOI: 10.1055/a-0626-7048

Abstract
Background and study aims
 The first-line approach to anastomotic biliary stricture after orthotopic liver transplantation (OLTX) involves endoscopic retrograde cholangiopancreatography (ERCP). The most widely used technique is placement of multiple plastic stents, but discussions are ongoing on the benefits of fully-covered self-expandable metallic stents (FCEMS) in this situation. This study aimed to compare results from use of plastic and metal stents to treat biliary stricture after transplantation.
Patients and methods
 Searches were performed in the Medline, EMBASE, SciELO/LILACS, and Cochrane databases, and only randomized studies comparing the two techniques were included in the meta-analysis.
Results
 Our study included four randomized clinical trials totaling 205 patients. No difference was observed between the stricture resolution rate (RD: 0.01; 95 %CI [−0.08 – 0.10]), stricture recurrence (RD: 0.13; 95 %CI [−0.03 – 0.28]), and adverse events (RD: −0.10; 95 %CI [−0.65 – 0.44]) between the plastic and metallic stent groups. The metallic stent group demonstrated benefits in relation to the number of ERCPs performed (MD: −1.86; 95 %CI [−3.12 to −0.6]), duration of treatment (MD: −105.07; 95 %CI [−202.38 to −7.76 days]), number of stents used (MD: −10.633; 95 %CI [−20.82 to −0.44]), and cost (average $ 8,288.50 versus $ 18,580.00,
P
 < 0.001).
Conclusions
 Rates of resolution and recurrence of stricture are similar, whereas the number of ERCPs performed, number of stents used, duration of treatment, and costs were lower in patients treated with FCEMS, which shows that this device is a valid option for initial treatment of post-OLTX biliary stricture.