Ge Phillip S, Hamerski Christopher M, Watson Rabindra R, Komanduri Srinadh, Cinnor Birtukan B, Bidari Kiran, Klapman Jason B, Lin Cui L, Shah Janak N, Wani Sachin, Donahue Timothy R, Muthusamy V Raman
Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA.
Gastrointest Endosc. 2015 Feb;81(2):360-6. doi: 10.1016/j.gie.2014.08.020. Epub 2014 Oct 16.
Plastic stents in patients with biliary obstruction caused by pancreatic adenocarcinoma are typically exchanged at 3-month intervals. Plastic stents may have reduced durability in patients receiving chemotherapy.
To determine the duration of plastic biliary stent patency in patients undergoing chemotherapy for pancreatic adenocarcinoma.
Retrospective, multicenter cohort study.
Three tertiary academic referral centers.
A total of 173 patients receiving downstaging chemotherapy for locally advanced or borderline resectable pancreatic adenocarcinoma from 1996 to 2013.
Placement of 10F or larger plastic biliary stents.
Primary outcome was overall duration of stent patency. Secondary outcomes included the incidence of premature stent exchange (because of cholangitis or jaundice) and hospitalization rates.
A total of 233 plastic stents were placed, and the overall median duration of stent patency was 53 days (interquartile range [IQR] 25-99 days). Eighty-seven stents were removed at the time of surgical resection, and 63 stents were exchanged routinely per protocol. The remaining 83 stent exchanges were performed for worsening liver function test results, jaundice, or cholangitis, representing a 35.6% rate of premature stent exchange. The median stent patency duration in the premature stent exchange group was 49 days (IQR 25-91 days) with a 44.6% hospitalization rate. The overall rate of cholangitis was 15.0% of stent exchanges, occurring a median of 56 days after stent placement (IQR 26-89 days).
Retrospective study.
Plastic biliary stents placed during chemotherapy/chemoradiation for pancreatic adenocarcinoma have a shorter-than-expected patency duration, and a substantial number of patients will require premature stent exchange. Consideration should be given to shortening the interval for plastic biliary stent exchange.
对于因胰腺腺癌导致胆道梗阻的患者，塑料支架通常每3个月更换一次。在接受化疗的患者中，塑料支架的耐用性可能会降低。
确定接受化疗的胰腺腺癌患者塑料胆道支架通畅的持续时间。
回顾性多中心队列研究。
三个三级学术转诊中心。
1996年至2013年期间，共有173例接受降期化疗的局部晚期或边界可切除胰腺腺癌患者。
放置10F或更大尺寸的塑料胆道支架。
主要结局是支架通畅的总持续时间。次要结局包括过早更换支架（由于胆管炎或黄疸）的发生率和住院率。
共放置了233个塑料支架，支架通畅的总体中位持续时间为53天（四分位间距[IQR]25 - 99天）。87个支架在手术切除时取出，63个支架按方案常规更换。其余83次支架更换是因为肝功能检查结果恶化、黄疸或胆管炎，过早更换支架的发生率为35.6%。过早更换支架组的中位支架通畅持续时间为49天（IQR 25 - 91天），住院率为44.6%。胆管炎的总体发生率为支架更换的15.0%，发生在支架置入后的中位时间为56天（IQR 26 - 89天）。
回顾性研究。
在胰腺腺癌化疗/放化疗期间放置的塑料胆道支架通畅持续时间短于预期，相当数量的患者需要过早更换支架。应考虑缩短塑料胆道支架更换的间隔时间。
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