Endoscopy Unit, Service of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Sant Quintí 89, 08041, Barcelona, Spain.
Surg Endosc. 2012 Jan;26(1):222-9. doi: 10.1007/s00464-011-1858-z. Epub 2011 Aug 20.
Endoscopic biliary stenting is a well-established palliative treatment in patients with unresectable malignant biliary strictures. Obstruction of uncovered self-expanding metal stent (SEMS) due to tumor ingrowth is the most frequent complication. Partially covered SEMS might increase stent patency but could favor complications related to stent covering, such as pancreatitis, cholecystitis, and migration. The aim of this study was to evaluate the efficacy and safety of partially covered SEMS in patients with an unresectable malignant biliary stricture.
Patients with malignant extrahepatic biliary obstruction treated endoscopically with partially covered SEMS were included in this multicenter, prospective, nonrandomized study.
One hundred ninety-nine patients were endoscopically treated with partially covered SEMS in 32 Spanish hospitals. Clinical success after deep cannulation was 96%. Early complications occurred in 4% (3 pancreatitis, 2 cholangitis, 1 hemorrhage, 1 perforation, and 1 cholecystitis). Late complications occurred in 19.5% (18 obstructions, 10 migrations, 6 cholangitis without obstruction, 3 acute cholecystitis, and 2 pancreatitis), with no tumor ingrowth in any case. Median stent patency was 138.9 ± 112.6 days. One-year actuarial probability of stent patency was 70% and that of nonmigration was 86%. Multivariate analysis showed adjuvant radio- or chemotherapy as the only independent predictive factor of stent patency and previous insertion of a biliary stent was the only predictive factor of migration.
The partially covered SEMS was easily inserted, had a high clinical success rate, and prevented tumor ingrowth. The incidence of possible complications related to stent coverage, namely, migration, pancreatitis, and cholecystitis, was lower than in previously published series.
内镜下胆道支架置入术是治疗不可切除的恶性胆道狭窄患者的一种成熟的姑息性治疗方法。肿瘤生长导致uncovered 自膨式金属支架（SEMS）阻塞是最常见的并发症。部分覆盖 SEMS 可能会增加支架通畅率，但可能会增加与支架覆盖相关的并发症，如胰腺炎、胆囊炎和迁移。本研究旨在评估部分覆盖 SEMS 在不可切除的恶性胆道狭窄患者中的疗效和安全性。
本研究为多中心前瞻性非随机研究，纳入了接受内镜下部分覆盖 SEMS 治疗的恶性肝外胆道梗阻患者。
32 家西班牙医院的 199 例患者接受了内镜下部分覆盖 SEMS 治疗。深穿刺后的临床成功率为 96%。早期并发症发生率为 4%（3 例胰腺炎，2 例胆管炎，1 例出血，1 例穿孔，1 例胆囊炎）。晚期并发症发生率为 19.5%（18 例阻塞，10 例迁移，6 例无阻塞性胆管炎，3 例急性胆囊炎，2 例胰腺炎），无肿瘤生长。中位支架通畅时间为 138.9±112.6 天。1 年支架通畅率的累积概率为 70%，非迁移率为 86%。多变量分析显示辅助放化疗是支架通畅的唯一独立预测因素，而先前插入胆道支架是迁移的唯一预测因素。
部分覆盖 SEMS 易于插入，具有较高的临床成功率，并可防止肿瘤生长。与支架覆盖相关的潜在并发症（即迁移、胰腺炎和胆囊炎）的发生率低于先前发表的系列研究。
