title: A randomized trial of a fully covered self-expandable metallic stent versus plastic stents in anastomotic biliary strictures after liver transplantation.
abstract: BACKGROUND
  Post-liver-transplant biliary anastomotic strictures (ASs) are currently managed with repeated endoscopic retrograde cholangiopancreatographies (ERCPs) inserting multiple plastic stents. Fully covered self-expanding metal stents (FCSEMSs) are being increasingly reported in the management of this condition, however no prospective randomized trials have been performed to date.
  
  
  OBJECTIVE
  The aim of this study was to determine whether FCSEMSs decrease overall numbers of ERCPs needed to achieve stricture resolution and to establish the safety, efficacy and cost-effectiveness in this setting.
  
  
  METHODS
  Two tertiary referral centres performed this open-label prospective randomized trial. A total of 32 patients consented and subsequently 20 were randomized with 10 in the FCSEMS arm and 10 in the plastic arm. The FCSEMS arm had the stent in situ for 12 weeks with the plastic stent arm undergoing 3-monthly multiple plastic stenting with or without dilatation over a year.
  
  
  RESULTS
  The median number of ERCPs performed per patient in the FCSEMS was 2 versus 4.5 (p = 0.0001) in the plastic stenting arm. Stricture resolution was achieved in all 10 patients with FCSEMSs compared with 8/10 in the plastic arm [p = not significant (NS)]. Complications occurred in 1/10 patients in the FCSEMS arm versus 5/10 in the plastic arm (p = 0.051). Days in hospital for complications was 6 in the FCSEMS versus 56 in the plastic arm (p = 0.11). Cost analysis shows that the FCSEMS arm was more cost effective. No cases of FCSEMS migration were seen.
  
  
  CONCLUSIONS
  FCSEMSs reduced the number of ERCPs needed to achieve stricture resolution with similar recurrence rates between arms. The FCSEMSs may do so with fewer complications making it cost effective.
authors.affiliation: Royal Prince Alfred Hospital - AW Morrow Gastroenterology and Liver Centre, Missenden Road, Camperdown, Sydney, New South Wales 2050, Australia.
authors.forename: Arthur
authors.initials: A
authors.lastname: Kaffes
authors.affiliation: Royal Prince Alfred Hospital - AW Morrow Gastroenterology and Liver Centre, New South Wales, Australia.
authors.forename: Sean
authors.initials: S
authors.lastname: Griffin
authors.affiliation: Austin Hospital - Gastroenterology, Victoria, Australia.
authors.forename: Rhys
authors.initials: R
authors.lastname: Vaughan
authors.affiliation: Wolfson Digestive Disease Biomedical Research Unit - Gastroenterology, Nottingham, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: James
authors.affiliation: Royal Prince Alfred Hospital - AW Morrow Gastroenterology and Liver Centre, New South Wales, Australia.
authors.forename: Tee
authors.initials: T
authors.lastname: Chua
authors.affiliation: Royal Prince Alfred Hospital - AW Morrow Gastroenterology and Liver Centre, New South Wales, Australia.
authors.forename: Hoi
authors.initials: H
authors.lastname: Tee
authors.affiliation: Royal Prince Alfred Hospital - AW Morrow Gastroenterology and Liver Centre, New South Wales, Australia.
authors.forename: Lotte
authors.initials: L
authors.lastname: Dinesen
authors.affiliation: Royal Prince Alfred Hospital - AW Morrow Gastroenterology and Liver Centre, New South Wales, Australia.
authors.forename: Crispin
authors.initials: C
authors.lastname: Corte
authors.affiliation: Royal Prince Alfred Hospital - AW Morrow Gastroenterology and Liver Centre, New South Wales, Australia.
authors.forename: Raghubinder
authors.initials: R
authors.lastname: Gill
keywords: ERCP; SEMS; biliary; biliary strictures; liver transplant