title: The Efficacy and Safety of Endoscopic Balloon Dilation Combined with Stenting in Patients with Biliary Anastomotic Strictures After Orthotopic Liver Transplantation.
abstract: Endoscopic balloon dilation combined with stenting has been increasingly used in managing biliary anastomotic strictures (BAS) after orthotopic liver transplantation (OLT). However, data on the efficacy and safety vary among different studies. To obtain reliable estimates for the efficacy and safety of this endoscopic combination therapy in post-OLT BAS. A systematic search was conducted in the literature published until June 2012. The outcomes of individual study were transformed into comparable data using the Freeman-Tukey double arcsine transformation method. Fixed-effect or random-effect models were built to simulate the outcomes. Subgroup analysis and meta-regression were used to explore the sources of clinical heterogeneity. Clinical resolution and recurrence were defined as the primary outcomes and complications and mortality as secondary outcomes. Nineteen studies (15 retrospective, 4 prospective; 17 full-texts, 2 abstracts) were included, with a total of 745 patients. Fully covered self-expandable metal stent was only reported in one study, achieving a resolution rate of 92.3 %, recurrence rate of 8.3 %, and complication rate of 7.7 %. For 18 studies using plastic stents, the pooled resolution rate was 86 % (95 % CI 80-91 %; I (2) = 74.7 %). Abstracts, study design, and the delay from OLT to BAS diagnosis were contributing factors for heterogeneity in resolution. The pooled recurrence rate was 9 % (95 % CI 5-13 %; I (2) = 59.6 %). Longer stenting duration predicted less recurrence (OR = 0.95, p = 0.002). The pooled complication rate was 14 % (95 % CI 8-21 %, I (2) = 71.2 %). No procedure-related mortality was reported. Endoscopic balloon dilation combined with stenting is a relatively effective and safe modality in post-OLT BAS.
authors.affiliation: Department of Gastroenterology, The Drum Tower Hospital Affiliated to Medical School of Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China.|Drum Tower Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China.
authors.forename: Chunyan
authors.initials: C
authors.lastname: Peng
authors.affiliation: Drum Tower Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China.
authors.forename: Chao
authors.initials: C
authors.lastname: Ma
authors.affiliation: Department of Gastroenterology, The Drum Tower Hospital Affiliated to Medical School of Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China.
authors.forename: Guifang
authors.initials: G
authors.lastname: Xu
authors.affiliation: Department of Gastroenterology, The Drum Tower Hospital Affiliated to Medical School of Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China.
authors.forename: Shanshan
authors.initials: S
authors.lastname: Shen
authors.affiliation: Department of Gastroenterology, The Drum Tower Hospital Affiliated to Medical School of Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Lv
authors.affiliation: Department of Gastroenterology, The Drum Tower Hospital Affiliated to Medical School of Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China. zhouxpdh@163.com.
authors.forename: Xiaoping
authors.initials: X
authors.lastname: Zou
mesh_terms: D001649:Bile Duct Diseases / Q000209:etiology / Q000601:surgery*; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D011183:Postoperative Complications; D000071085:Single-Balloon Enteroscopy / Q000009:adverse effects* / Q000379:methods; D015607:Stents / Q000009:adverse effects*
keywords: Biliary anastomotic stricture; Endoscopic balloon dilation; Liver transplantation; Stent