P215 Tertiary centre experience of Kaffes stents for the treatment of post-liver transplant anastomotic biliary strictures

Introduction

Anastomotic strictures (AS) occur in around 30% of patients following liver transplantation. Herein, we present our experience of endoscopic management of AS focussing on those treated with Kaffes stents.

Methods

AS are usually treated by endoscopic dilatation and plastic stent (PS) insertion. AS can often recur following PS with patients requiring multiple procedures. Kaffes stents (KS, Taewoong Medical) are designed to be removable and can be deployed across AS. We compared a cohort of patients treated using KS with our cohort of patients who were initially treated with PS.

Results

22 patients (12 females) were treated with KS, 4 post PS failure; mean age 55 years (range 22–69). 11 patients had DBD and 11 DCD grafts; mean cold ischaemia time was 9.6±3.3 hours. To date, 16/18 patients initially treated with KS have had it removed. The 69 patients (20 female) treated by PS were similar, mean age of 51 (range 28–79) years; 47 patients had DBD and 22 DCD grafts; mean cold ischaemia time was 8.9±3.1 hours. When used 1^st line, AS resolved in 14/16 patients (88%) compared to 26/69 patients (38%) receiving PS 1^st line (relative risk of persistent stricture (KS vs PS) =0.2, 95% CI 0.05–0.74; p=0.016; number to treat by KS for one benefit=2, 95% CI 1.3–4.0). There were no significant complications, including stent migration, after KS compared to 6 (8.4%) in the PS group (3 cholangitis, 2 pancreatitis, and 1 bleeding). All KS were removed successfully, although 1 stent needed 2 attempts because of thread migration upstream. Following initial ERCP, PS patients required more ERCPs (mean 2.71 vs 1.13 more; p<0.01). 32% of the PS treated patient’s required biliary reconstruction.

Conclusions

Our data indicate that the KS is a promising treatment for post-transplant AS. In comparison to PS, majority of strictures are treated by deployment of a single stent at first ERCP.