P137 Intraductal Fully Covered Self-Expanding Metal Stents in Biliary Strictures: a UK Multicentre Experience

Introduction Fully covered intraductal self-expanding metal stents (IDSEMS) have been well described in the management of post-liver transplant anastomotic strictures (AS). They are increasingly used in a non-transplant (NT) setting. We conducted a multi-centre study across nine tertiary centres in the UK to analyse their use and efficacy Methods Consecutive patients who underwent Endoscopic Retrograde Cholangiopancreatography (ERCP) with insertion of IDSEMS were retrospectively analysed. Results 178 episodes (109 males, 61%) were identified. 162 (91%) underwent IDSEMS stent insertion for AS and 16 (9%) for a NT indication. Age at transplant was 54 years (range 12-74) and stent duration was 15 weeks (range three days-78 weeks). 131 (81%) had complete resolution of stricture at endoscopic re-evaluation. Stricture recurrence was observed in 13 (10%) cases. The most frequent indication for stenting in the NT setting was bile leak post partial hepatectomy (n=8, 50%). In the NT cohort, stent duration was 15 weeks (range 2- 41 weeks). 10 (83%) patients had complete resolution of biliary pathology on stent removal. At removal, there were 26 (14%) adverse events, five (3%) episodes of cholangitis and two (1%) of pancreatitis. In 13 (7%) cases the removal wires unravelled, 3 (2%) stents migrated, and three (2%) stents were embedded. All were removed endoscopically. Conclusions IDSEMS appear to be safe and highly efficacious in the management of post-liver transplant AS, with low rates of AS recurrence. IDSEMS can be effectively used in the non-transplant setting.