Comparison of endoscopic stenting for malignant biliaryobstruction： A single-center study

• 作者: Katsuya Chinen Koji Yakabi. Masatomo Takahashi Ryuichi Yamamoto Shingo Kato Sumiko Nagoshi Yasuyo Osafune
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: Endoscopic STENTING SINGLE-STEP Malignantbiliary OBSTRUCTION Self-expandable metallic STENTS Twostep
• 年，卷（期）: 2015,（9）
• 页码范围: 889-894
• 页数: 6页
• 分类号: R

摘要

AIM： To evaluate the efficacy and safety of single-stependoscopic placement of self-expandable metallic stents（SEMS） for treatment of obstructive jaundice.METHODS： A retrospective study was performedamong 90 patients who underwent transpapillarybiliary metallic stent placement for malignant biliaryobstruction （MBO） between April 2005 and October2012. The diagnosis of primary disease and MBO wasbased on abdominal ultrasound, computed tomography,magnetic resonance imaging, endoscopic ultrasound,endoscopic retrograde cholangiopancreatography withbrush cytology, biopsy, and/or a combination of thesemodalities. The type of SEMS （covered or non-covered,8 mm or 10 mm in diameter） was determined by theendoscopist. Ninety patients were divided into twogroups： group 1 （49 patients） who underwent a singlestepSEMS placement and group 2 （41 patients） whounderwent a two-step SEMS placement. The technicalsuccess rate, complication rate, stent patency, andpatient survival rate were compared between thegroups. In addition, to identify the clinical prognosticfactors associated with patient survival, the followingvariables were evaluated in Cox-regression analysis：gender, age, etiology of MBO （pancreatic cancer or nonpancreaticcancer）, clinical stage （Ⅳb; with distant metastases or Ⅳa 〉; without distant metastases）,chemotherapy （with or without）, patency of the stent,and the use of single-step or two-step SEMS.RESULTS： Immediate technical success was achievedin 93.9% （46/49） in group 1 and in 95.1% （39/41）in group 2, with no significant difference （P = 1.0）.Similarly, there was no difference in the complicationrates between the groups （group 1, 4.1% and group 2,4.9%; P = 0.62）. Stent failure was observed in 10 casesin group 1 （20.4%） and in 16 cases in group 2 （39.0%）.The patency of stent and patient survival revealed nodifference between the two groups with Kaplan-Meieranalysis, with a mean patency of 111 ± 17 d in group1 and 137 ± 19 d in group 2 （P = 0.9