Yamaguchi Taketo, Ishihara Takeshi, Seza Katsutoshi, Nakagawa Akihiko, Sudo Kentarou, Tawada Katsuyuki, Kouzu Teruo, Saisho Hiromitsu
Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
World J Gastroenterol. 2006 Jan 21;12(3):426-30. doi: 10.3748/wjg.v12.i3.426.
Endoscopic metal stenting (EMS) offers good results in short to medium term follow-up for bile duct stenosis associated with chronic pancreatitis (CP); however, longer follow-up is needed to determine if EMS has the potential to become the treatment of first choice.
EMS was performed in eight patients with severe common bile duct stenosis due to CP. After the resolution of cholestasis by endoscopic naso-biliary drainage three patients were subjected to EMS while, the other five underwent EMS following plastic tube stenting. The patients were followed up for more than 5 years through periodical laboratory tests and imaging techniques.
EMS was successfully performed in all the patients. Two patients died due to causes unrelated to the procedure: one with an acute myocardial infarction and the other with maxillary carcinoma at 2.8 and 5.5 years after EMS, respectively. One patient died with cholangitis because of EMS clogging 3.6 years after EMS. None of these three patients had showed symptoms of cholestasis during the follow-up period. Two patients developed choledocholithiasis and two suffered from duodenal ulcers due to dislodgement of the stent between 4.8 and 7.3 years after stenting; however, they were successfully treated endoscopically. Thus, five of eight patients are alive at present after a mean follow-up period of 7.4 years.
EMS is evidently one of the very promising treatment options for bile duct stenosis associated with CP, provided the patients are closely followed up; thus setting a system for their prompt management on emergency is desirable.
内镜金属支架置入术（EMS）在慢性胰腺炎（CP）相关胆管狭窄的短期至中期随访中效果良好；然而，需要更长时间的随访来确定EMS是否有潜力成为首选治疗方法。
对8例因CP导致严重胆总管狭窄的患者进行了EMS。在内镜鼻胆管引流解除胆汁淤积后，3例患者接受了EMS，另外5例在塑料支架置入术后接受了EMS。通过定期实验室检查和影像学技术对患者进行了5年以上的随访。
所有患者均成功进行了EMS。2例患者因与手术无关的原因死亡：1例在EMS后2.8年死于急性心肌梗死，另1例在EMS后5.5年死于上颌癌。1例患者在EMS后3.6年因EMS堵塞死于胆管炎。这3例患者在随访期间均未出现胆汁淤积症状。2例患者在支架置入后4.8至7.3年发生胆总管结石，2例因支架移位患十二指肠溃疡；然而，他们通过内镜成功治疗。因此，8例患者中有5例在平均随访7.4年后目前仍存活。
EMS显然是CP相关胆管狭窄非常有前景的治疗选择之一，前提是对患者进行密切随访；因此，建立一个紧急情况下对其进行及时管理的系统是可取的。
