Walter Dirk, Sarrazin Christoph, Trojan Jörg, Kronenberger Bernd, Bojunga Jörg, Zeuzem Stefan, Friedrich-Rust Mireen, Albert Jörg G
Department of Internal Medicine I, Johann Wolfgang Goethe-University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany,
Dig Dis Sci. 2015 Aug;60(8):2495-501. doi: 10.1007/s10620-015-3656-2. Epub 2015 Apr 14.
Fully covered self-expandable metal stents (FCSEMS) are increasingly used for treatment of benign common bile duct (CBD) stricture or leakage, but dislodgement of FCSEMS is frequent.
To compare dislocation rate and clinical outcome of a standard fixed cell structure FCSEMS (S-FCSEMS) to a novel FCSEMS with an unfixed cell structure (N-FCSEMS).
We performed a retrospective analysis of all patients with FCSEMS insertion for benign biliary disease at our Hospital from 03/2008 to 03/2014. Both stent types N-FCSEMS and S-FCSEMS were applied as available unrelated to the indication.
Twenty-nine patients (S-FCSEMS: 18, N-FCSEMS: 11) were included. Stent placement was technically successful in 28/29 (96.6 %) patients; stent removal was successful in 26/27 (96.2 %). Two patients with N-FCSEMS were excluded due to unsuccessful placement and withdrawal of consent for stent removal, respectively. Stent migration into the duodenum (distal migration) was observed in 9/18 (50 %) in the S-FCSEMS group compared to 0/9 in the N-FCSEMS (p < 0.005). FCSEMS migration into the CBD (proximal migration) was found in 2/18 (11 %, S-FCSEMS) versus 2/9 (22 %, N-FCSEMS, p = 0.514). A foreshortening of the N-FCSEMS occurred in 3/9 patients (33 %) compared to 0/18 S-FCSEMS (p = 0.08). Clinical resolution of the treated CBD-disease was observed in 5/9 (56 %, N-FCSEMS) versus 12/18 (67 %, S-FCSEMS) at the time of stent removal (p = 0.604) and in 0/9 and 10/18 (56 %) cases during follow-up, respectively (p < 0.005).
An unfixed cell structure of FCSEMS seems to prevent distal migration, but proximal migration still occurs and foreshortening of the N-FCSEMS constrains clinical outcome.
全覆膜自膨式金属支架（FCSEMS）越来越多地用于治疗良性胆总管（CBD）狭窄或渗漏，但FCSEMS移位很常见。
比较标准固定细胞结构FCSEMS（S-FCSEMS）与新型非固定细胞结构FCSEMS（N-FCSEMS）的移位率和临床结果。
我们对2008年3月至2014年3月在我院因良性胆道疾病置入FCSEMS的所有患者进行了回顾性分析。N-FCSEMS和S-FCSEMS两种支架类型根据可获得情况应用，与适应证无关。
纳入29例患者（S-FCSEMS组18例，N-FCSEMS组11例）。28/29例（96.6%）患者支架置入技术成功；26/27例（96.2%）患者支架取出成功。分别有2例N-FCSEMS患者因置入失败和撤回支架取出同意书而被排除。S-FCSEMS组9/18例（50%）观察到支架向十二指肠移位（远端移位），而N-FCSEMS组为0/9例（p<0.005）。S-FCSEMS组18例中有2例（11%）发现FCSEMS向CBD近端移位，N-FCSEMS组9例中有2例（22%）（p=0.514）。3/9例（33%）N-FCSEMS患者出现缩短，而S-FCSEMS组为0/18例（p=0.08）。在支架取出时，N-FCSEMS组5/9例（56%）与S-FCSEMS组12/18例（67%）观察到治疗的CBD疾病临床缓解（p=0.604），随访期间分别为0/9例和10/18例（56%）（p<0.005）。
FCSEMS的非固定细胞结构似乎可防止远端移位，但近端移位仍会发生，且N-FCSEMS缩短限制了临床结果。
