Kaya M, Petersen B T, Angulo P, Baron T H, Andrews J C, Gostout C J, Lindor K D
Division of Gastroenterology and Hepatology, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
Am J Gastroenterol. 2001 Apr;96(4):1059-66. doi: 10.1111/j.1572-0241.2001.03690.x.
In some patients with primary sclerosing cholangitis (PSC), a localized, high-grade (dominant) stricture may be the principal cause of symptoms and hyperbilirubinemia. The aim of this retrospective study was to compare the beneficial effects and risk of balloon dilation alone versus dilation followed by stenting in PSC patients with dominant strictures.
Charts from a group of 1009 patients with PSC seen over 10 yr were reviewed to identify those patients who had undergone endoscopic or percutaneous therapeutic intervention. Procedural and clinical data were recorded.
A total of 71 PSC patients, median age of 49 yr (range 18-78 yr) were identified. Thirty-four patients were treated with endoscopic balloon dilation alone, and 37 patients were treated with balloon dilation plus stent placement. Stents were placed percutaneously (n = 19), endoscopically (n = 14), or using both interventions (n = 4). Both groups were comparable at baseline with regards to age, symptoms, and bilirubin level. The median duration of follow-up after intervention was similar in both groups. The number of intervention-related complications (30 vs 6, p = 0.001) as well as the incidence of acute cholangitis (p = 0.004) were more common in the stent group compared to the balloon dilation group. There were more complications related to percutaneous stent placement than endoscopic placement (23 vs 7. p = 0.001). There was no significant difference between the two groups with regards to improving cholestasis.
There was no additional obvious benefit from stenting after balloon dilation in the treatment of dominant strictures in PSC patients. Stenting was associated with more complications, and its role after dilation should be assessed in a randomized trial rather than being accepted as routinely indicated in this setting.
在一些原发性硬化性胆管炎（PSC）患者中，局部的、高度（主导性）狭窄可能是症状和高胆红素血症的主要原因。这项回顾性研究的目的是比较单纯球囊扩张与球囊扩张后再置入支架对PSC主导性狭窄患者的益处和风险。
回顾10年间诊治的1009例PSC患者的病历，以确定那些接受过内镜或经皮治疗干预的患者。记录操作和临床数据。
共确定71例PSC患者，中位年龄49岁（范围18 - 78岁）。34例患者仅接受内镜下球囊扩张治疗，37例患者接受球囊扩张加支架置入治疗。支架通过经皮置入（n = 19）、内镜置入（n = 14）或两种方法联合使用（n = 4）。两组在年龄、症状和胆红素水平方面基线可比。两组干预后的中位随访时间相似。与干预相关的并发症数量（30例对6例，p = 0.001）以及急性胆管炎的发生率（p = 0.004）在支架置入组比球囊扩张组更常见。经皮支架置入比内镜置入相关并发症更多（23例对7例，p = 0.001）。两组在改善胆汁淤积方面无显著差异。
对于PSC患者主导性狭窄的治疗，球囊扩张后再置入支架并无额外明显益处。支架置入与更多并发症相关，其在扩张后的作用应通过随机试验评估，而非在此情况下被常规采用。
