Multi-center study of endoscopic revision after side-by-side metal stent placement for malignant hilar biliary obstruction
Multi-center study of endoscopic revision after side-by-side metal stent placement for malignant hilar biliary obstruction
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DOI：
10.1111/den.13854
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发表时间：
2020-11-11
影响因子：
5.3
通讯作者：
Yoneda, Masashi
中科院分区：
文献类型：
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作者：
Inoue, Tadahisa;Naitoh, Itaru;Yoneda, Masashi
背景：最近超薄输送系统的发展，使两个金属支架的同时插入，鼓励更广泛地采用并排（SBS）支架放置恶性肝门胆管梗阻（MHBO）。然而，SBS置入后支架闭塞的管理尚未得到很好的表征。本研究旨在检查SBS放置后MHBO患者内镜下再介入（E-RI）的结局。方法对2013年至2020年期间在三个三级护理转诊中心接受E-RI治疗SBS放置后支架闭塞的67例患者进行了调查。我们评估了与E-RI相关的技术成功率、临床成功率、复发性胆道梗阻（RBO）和除RBO率以外的不良事件。结果67例患者中，技术成功率为79.1%（53/67），临床成功率为76.1%（51/67）。除RBO以外的早期不良事件发生率为4.5%（3/67），晚期不良事件发生率为3.9%（2/51）。E-RI后RBO发生率为52.9%（27/51），E-RI后至RBO的中位时间为85天。胆总管（CBD）直径（比值比2.62; 95%置信区间，1.37-5.01; P = 0.003）和转移性疾病（比值比，0.11; 95%置信区间，0.02-0.64; P = 0.015）在多变量分析中与E-RI成功独立相关。SBS置入后的RI在技术上是可行和安全的，但在狭窄CBD和转移性疾病患者中成功率明显较低。这些因素可能有助于选择初始支架植入方法。
Background The recent development of ultra-thin delivery systems, which enable simultaneous insertion of two metal stents, has encouraged wider adoption of side-by-side (SBS) stent placement for malignant hilar biliary obstruction (MHBO). However, the management of stent occlusion after SBS placement has not been well-characterized. This study aimed to examine the outcomes of endoscopic reintervention (E-RI) after SBS placement in patients with MHBO.Methods Sixty-seven patients who underwent E-RI for stent occlusion after SBS placement between 2013 and 2020 at three tertiary-care referral centers were investigated. We evaluated the technical success, clinical success, recurrent biliary obstruction (RBO), and adverse events other than RBO rates associated with E-RI. Furthermore, the factors associated with successful E-RI were also evaluated.Results The technical success and clinical success rates were 79.1% (53/67) and 76.1% (51/67), respectively. Early adverse events other than RBO occurred in 4.5% (3/67) and late events in 3.9% (2/51). The RBO rate after E-RI was 52.9% (27/51), and the median time to RBO after E-RI was 85 days. Common bile duct (CBD) diameter (odds ratio 2.62; 95% confidence interval, 1.37-5.01; P = 0.003) and metastatic disease (odds ratio, 0.11; 95% confidence interval, 0.02-0.64; P = 0.015) were independently correlated with E-RI success in the multivariate analysis.Conclusions This study demonstrated that E-RI after SBS placement is technically feasible and safe, but the success rate was significantly lower in patients with narrow CBDs and metastatic diseases. These factors may be useful for the selection of the initial stenting method.