Predictive factors for pancreatitis and cholecystitis in endoscopic covered metal stenting for distal malignant biliary obstruction
Predictive factors for pancreatitis and cholecystitis in endoscopic covered metal stenting for distal malignant biliary obstruction
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DOI：
10.1111/j.1440-1746.2012.07283.x
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发表时间：
2013-01-01
影响因子：
4.1
通讯作者：
Joh, Takashi
中科院分区：
文献类型：
--
作者：
Shimizu, Shuya;Naitoh, Itaru;Joh, Takashi
背景和目的：胰腺炎和胆囊炎是自膨式金属支架（SEMS）治疗远端恶性胆道梗阻后的主要并发症。我们的目的是澄清胰腺炎和胆囊炎的预测因素后，覆盖SEMS placement.Methods：我们回顾性分析了74例连续远端恶性胆道梗阻谁接受了初步内镜引流使用覆盖SEMS。结果：胰腺炎和胆囊炎的发生率分别为10.8%（8/74）和6.1%（4/66）。单因素分析显示，非胰腺癌（P = 0.018）和造影剂注入胰管（P = 0.030）是胰腺炎的重要预测因素。多变量分析显示，非胰腺癌（比值比[OR]，4.21; 95%置信区间[CI]，1.63-14.18; P = 0.007）和造影剂注入胰管（OR，3.34; 95% CI，1.33-9.60; P = 0.016）是胰腺炎的重要独立预测因素。另一方面，单因素和多因素分析显示，肿瘤累及胆囊管口（OCD）是胆囊炎的一个重要独立预测因素（OR，5.85; 95%CI，1.91-27.74; P = 0.005）。非胰腺癌和造影剂注入胰管是胰腺炎的预测因素，肿瘤累及OCD是内镜下SEMS治疗远端恶性胆道梗阻后发生胆囊炎的阳性预测因素。
Background and Aim: Pancreatitis and cholecystitis are major complications after self-expandable metal stent (SEMS) placement in distal malignant biliary obstruction. We aimed to clarify predictive factors for pancreatitis and cholecystitis after covered SEMS placement.Methods: We retrospectively reviewed 74 consecutive patients with distal malignant biliary obstruction who underwent initial endoscopic drainage using covered SEMS. Predictive factors for pancreatitis and cholecystitis were evaluated in the 74 patients described above and in 66 patients who had not undergone cholecystectomy.Results: The incidences of pancreatitis and cholecystitis were 10.8% (8/74) and 6.1% (4/66), respectively. Univariate analysis revealed that non-pancreatic cancer (P = 0.018) and contrast injection into the pancreatic duct (P = 0.030) were significant predictive factors for pancreatitis. Multivariate analysis revealed that non-pancreatic cancer (odds ratio [OR], 4.21; 95% confidence interval [CI], 1.63-14.18; P = 0.007) and contrast injection into the pancreatic duct (OR, 3.34; 95% CI, 1.33-9.60; P = 0.016) were significant independent predictive factors for pancreatitis. On the other hand, univariate and multivariate analyses revealed that tumor involvement to the orifice of the cystic duct (OCD) was a significant independent predictive factor for cholecystitis (OR, 5.85; 95% CI, 1.91-27.74; P = 0.005).Conclusions: Non-pancreatic cancer and contrast injection into the pancreatic duct were predictive factors for pancreatitis, and tumor involvement to the OCD was a positive predictive factor for cholecystitis after endoscopic covered SEMS placement for distal malignant biliary obstruction.