Paolo Cantù1, Ilaria Tarantino2, Anna Baldan3, Massimiliano Mutignani4, Andrea Tringali5, Giovanni Lombardi6, Angelo Cerofolini7, Antonio Di Sario8, Giorgia Catalano9, Helga Bertani10, Davide Ghinolfi11, Valentina Boarino12, Enzo Masci13, Milutin Bulajic14, Antonio Pisani15, Alberto Fantin16, Dario Ligresti2, Luca Barresi2, Mario Traina2, Paolo Ravelli3, Edoardo Forti4, Federico Barbaro5, Guido Costamagna5, Luca Rodella7, Luca Maroni8, Mauro Salizzoni9, Rita Conigliaro10, Franco Filipponi11, Alberto Merighi12, Teresa Staiano13, Michela Monteleone17, Vincenzo Mazzaferro17, Elena Zucchi14, Maurizio Zilli14, Elena Nadal16, Roberto Rosa1,18, Giulio Santi1,18, Ilaria Parzanese1,18, Luciano De Carlis19, Maria Francesca Donato20, Pietro Lampertico18,20, Umberto Maggi21, Lucio Caccamo21, Giorgio Rossi18,21, Maurizio Vecchi1,18, Roberto Penagini1,18. 1. Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 2. Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy. 3. Digestive Endoscopy Unit, Department of Gastroenterology, Papa Giovanni XXIII Hospital, Bergamo, Italy. 4. Diagnostic and Interventional Digestive Endoscopy, Niguarda Ca' Granda Hospital, Milan, Italy. 5. Digestive Endoscopy Unit, Gemelli University Hospital, Catholic University, Rome, Italy. 6. Digestive Endoscopy Unit, A. Cardarelli Hospital, Napoli, Italy. 7. Emergency Endoscopy Unit, Borgo Trento Hospital, Verona, Italy. 8. Department of Gastroenterology and Transplantation, Gastroenterology Clinic, Polytechnic Marche University - United Hospitals of Ancona, Ancona, Italy. 9. Liver Transplant Center and General Surgery, A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy. 10. U.O.C. Gastroenterology and Digestive Endoscopy Unit, Nuovo Ospedale Civile Sant'Agostino Estense, Modena, Italy. 11. Hepatobiliary Surgery and Liver Transplantation Unit, Department of Oncology, Transplants and Advances in Medicine, University of Pisa Medical School Hospital, Pisa, Italy. 12. Gastroenterology and Endoscopy Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy. 13. Diagnostic and Therapeutic Endoscopy Unit, Foundation IRCCS Istituto Nazionale Tumori, Milan, Italy. 14. University Clinical Hospital "Santa Maria della Misericordia", Udine, Italy. 15. Gastroenterology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy. 16. Division of Gastroenterology, Department of Surgical, Oncological and Gastroenterological Sciences, Azienda Ospedaliera - Università di Padova, Padova, Italy. 17. Liver Surgery, Transplantation and Gastroenterology, University of Milan and Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy. 18. Università degli Studi, Milan, Italy. 19. Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Università degli Studi Milano-Bicocca, Milan, Italy. 20. Gastroenterology and Hepatology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy. 21. General Surgery and Liver Transplantation Unit, Department of Pathophysiology and Transplantation, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Abstract
BACKGROUND: The most appropriate endo-therapeutic approach to biliary anastomotic strictures is yet to be defined. AIM: To retrospectively report on the endo-therapy of duct-to-duct anastomotic strictures during 2013 in Italy. METHODS: Data were collected from 16 Endoscopy Units at the Italian Liver Transplantation Centers (BASALT study group). RESULTS: Complete endo-therapy and follow-up data are available for 181 patients: 101 treated with plastic multistenting, 26 with fully covered self-expandable metal stenting and 54 with single stenting. Radiological success was achieved for 145 patients (80%), that is, 88% of plastic multistenting, 88% of self-expandable metal stenting and 61% of single stenting (P < 0.001 vs plastic multistenting; P < 0.05 vs self-expandable metal stenting). After first-line endo-therapy failure, the patients underwent a second-line endo-therapy with plastic multistenting for 25%, fully covered self-expandable metal stenting for 53% and single stenting for 22% of cases, and radiological success was achieved for 84%, that is, 100%, 85% and 63% with plastic multistenting, self-expandable metal stenting and single stenting (P < 0.05 vs plastic multistenting or self-expandable metal stenting) respectively. Procedure-related complications occurred in 7.8% of endoscopic retrograde cholangiopancreatographies. Overall, clinical success was achieved in 87% of patients after a median follow-up of 25 months. CONCLUSION: Plastic multistenting is confirmed as the preferred first-line treatment, while fully covered self-expandable metal stenting as rescue option for biliary anastomotic strictures. Single stenting has sub-optimal results and should be abandoned.
BACKGROUND: The most appropriate endo-therapeutic approach to biliary anastomotic strictures is yet to be defined. AIM: To retrospectively report on the endo-therapy of duct-to-duct anastomotic strictures during 2013 in Italy. METHODS: Data were collected from 16 Endoscopy Units at the Italian Liver Transplantation Centers (BASALT study group). RESULTS: Complete endo-therapy and follow-up data are available for 181 patients: 101 treated with plastic multistenting, 26 with fully covered self-expandable metal stenting and 54 with single stenting. Radiological success was achieved for 145 patients (80%), that is, 88% of plastic multistenting, 88% of self-expandable metal stenting and 61% of single stenting (P < 0.001 vs plastic multistenting; P < 0.05 vs self-expandable metal stenting). After first-line endo-therapy failure, the patients underwent a second-line endo-therapy with plastic multistenting for 25%, fully covered self-expandable metal stenting for 53% and single stenting for 22% of cases, and radiological success was achieved for 84%, that is, 100%, 85% and 63% with plastic multistenting, self-expandable metal stenting and single stenting (P < 0.05 vs plastic multistenting or self-expandable metal stenting) respectively. Procedure-related complications occurred in 7.8% of endoscopic retrograde cholangiopancreatographies. Overall, clinical success was achieved in 87% of patients after a median follow-up of 25 months. CONCLUSION: Plastic multistenting is confirmed as the preferred first-line treatment, while fully covered self-expandable metal stenting as rescue option for biliary anastomotic strictures. Single stenting has sub-optimal results and should be abandoned.
Authors: Wafaa Ahmed; Dave Kyle; Amardeep Khanna; John Devlin; David Reffitt; Zeino Zeino; George Webster; Simon Phillpotts; Robert Gordon; Gareth Corbett; William Gelson; Manu Nayar; Haider Khan; Matthew Cramp; Jonathan Potts; Waleed Fateen; Hamish Miller; Bharat Paranandi; Matthew Huggett; Simon M Everett; Vinod S Hegade; Rebecca O'Kane; Ryan Scott; Neil McDougall; Phillip Harrison; Deepak Joshi Journal: Therap Adv Gastroenterol Date: 2022-09-26 Impact factor: 4.802