Multiple plastic stent (MPS) versus FCSEMS for managing post liver transplantation biliary stricture: a systematic review and meta-anlaysis of randomized controlled trial

Aims: Anastomotic stricture post liver trasnplasntation (LT) are one of the most common complications occuring in 4.5 – 32% of case. Multiple plastic stenting (MPS) has become the standard of endoscopic treatment but require multiple session with associated risk, cost and patients discomfort. Fully covered self expandable metal stent (FCSEMS) has been increasingly used in this setting. A recent systematic review including prospective studies did not evidence a clear advantage in using FCSEMS. Aim: A systematic review and meta-analysis of RCT comparing the role of FCSEMS and MPS in the treatment of AS post LT. Methods: we conducted a bibliographic search using PUBMED, EMBASE aimed at identifying available randomized trials comparing MPS versus FCSEMS in patients with AS post LTe from January 2000 to October 2017. Primary outcomes were stricture resolution, while secondary outcomes were recurrence rate, adverse events and number of procedure performed. Pooled estimates were computed using the random effects models. Results: Overall 3 RCTS, involving 127 patients were included. Stricture resolution and stricture recurrence were not statistically difference in both groups (OR = 0.58, 95% CI 0.07 – 4.85; OR = 1.97, 95% CI, 0.29 – 13.18, respectively). There was no difference in adverse events in both groups (OR 0.83 95% CI 0.19 – 3.67). Migration rate were equal in both groups (OR 1.34 95% CI 0.17 – 10.42). Mean number of ERCP procedure were greater in the FCSEMS (MD -2.83 95% CI -3.04- -2.63). Conclusions: FCSEMS and MPS had equal stricture resolution and recurrence rate. No difference was found in advere events and migration rate. FCSEMS require less number of procedure to achieve a stricture resolution

Covered versus uncovered metal stents for malignant gastric outlet obstruction : a systematic review and meta-analysis of RTCs

Aims: Comparing efficacy and safety of FCSEMS vs. USEMS in patients with GOOD Methods: A computerized medical search was performed by using MEDLINE, EMBASE, Cochrane Library, from 2000 to September 2017 aimed at identifying available randomized trials comparing C-SEMS versus U-SEMS in patients with GOOD. Primary outcomes were stent survival and patient survival, while secondary outcomes were clinical and technical success, adverse events, stent occlusion and migration Pooled estimates were computed using the random effects models. Results: Overall 7 RCTs were identified including 635 patients were included. Stent and patient survival did not statistically significantly differ between C-SEMS and U-SEMS groups (HR = 0.93, 95% CI, 0.66 \u2013 1.31; HR = 0.87, 95% CI, 0.64 \u2013 1.19, respectively). Clinical success and technical success were not statistical difference between two groups (OR 1.44 95% CI 0.68 \u2013 3.05, OR 1.17 95% CI 0.39 \u2013 3.52) U-SEMS was associated with lower risk of adverse events (OR 2.20 95% CI 1.37 \u2013 3.54) but with higher risk of tumor ingrowth (OR 0.30 95% CI 0.18 \u2013 0.49). C-SEMS was associated with higher risk of migration (OR 5.24 95% CI 2.26 \u2013 2.12 Conclusions: C-SEMS did not show statistically significant differences in terms of stent and patient survival as compared to U-SEMS although U-SEMS was associated with higher risk of tumor ingrowth and C-SEMS with migration. Further studies using new C-SEMS with anti migration system are needed