A Systematic Review on Efficacy and Safety of Partially and Fully Covered Self-Expandable Metal Stent (SEMS) Compared to Multiple Plastic Stents (MPS) in the Endoscopic Management of Anastomotic Biliary Stricture Post Orthotopic Liver Transplantation (OLT)
Bibliographic record
Abstract
Purpose: Anastomotic biliary strictures (AS) account for up to 80% of biliary strictures post OLT. Several case series have reported stricture resolution rates in the range of 60-90% with balloon dilatation and multiple plastic stents (MPS). This strategy requires multiple ERCPs with associated risks, cost and patient burden. More recently, partially and fully covered SEMSs have been increasingly utilized in this setting, given their larger diameter and easy removability. It is not clear whether there are clear advantages of using SEMS over MPS in all cases. Methods: A systematic review on SEMS and MPS placement for AS was performed after searching Medline and Embase databases using the search terms anastomotic/biliary/bile duct stricture, endoscopy and ERCP. Inclusion criteria were 1) anastomotic stricture post OLT, 2) MPS or partially or fully covered SEMS. Exclusion criteria were 1) non anastomotic stricture, 2) living donor liver transplant, 3) single plastic stent, 4) uncovered SEMS, 5) studies including <5 patients. Data on clinical success and complications were extracted and summarized. Results: From a total of 791 studies, 8 studies (N=441) utilizing MPS and 9 studies (N=199) utilizing SEMS fulfilled the inclusion and exclusion criteria (table 1 and table 2) and were included in this review. For the 8 MPS studies, the stricture resolution rates were higher when MPS duration was >6 months (88-100%) compared to those with <6 months (65-87%). The mean or median number of ERCPs per patient in MPS ranged between 3-4.2 and 2.5-3.5 when stenting duration was >6 months and <6 months, respectively. Five of the 8 SEMS studies involved previous plastic stenting plus balloon dilation. The stricture resolution rates were higher when SEMS duration was >3 months (80-95%) compared to those with <3 months (53-88%), but did not seem to differ whether there was previous plastic stenting plus balloon dilation or not (53-92% vs 67-95%). The mean or median number of ERCP per patient in SEMS ranged between 2.1-7.4 (3.4-7.4 in those with previous plastic stenting plus balloon dilation vs 2.1-3 in those without). Although the overall complication rates were low, SEMS migration rates were significant at 4-47%.Table: [160] Table 1. Results of studies utilizing multiple plastic stents + dilation in endoscopic management of AS post OLTTable: [160] Table 2. Results of studies utilizing partially or fully covered SEMS in endoscopic management of ASConclusion: Although SEMS appeared to be a promising option in the endoscopic management of AS post OLT, current evidence does not support its routine use.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.023 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.010 | 0.008 |
| Bibliometrics | 0.009 | 0.010 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".