Park Jin-Seok, Lee Sang Soo, Song Tae Jun, Park Do Hyun, Seo Dong-Wan, Lee Sung Koo, Han Seungbong, Kim Myung-Hwan
Digestive Disease Center, Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea.
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Endoscopy. 2016 May;48(5):440-7. doi: 10.1055/s-0042-101406. Epub 2016 Feb 26.
Fully covered, self-expandable metal stents (FCSEMSs) are acceptable tools for treating benign biliary stricture (BBS). However, little is known about the long-term outcomes of this technique. The aim of the present study was to evaluate the procedural and long-term outcomes of FCSEMSs for treating BBSs.
A total of 134 consecutive patients (median age 56 years; range 21 - 83) with BBS were retrospectively reviewed. The main outcomes were technical and clinical success, stricture resolution, recurrence, and adverse events. Outcomes were analyzed by reviewing patient medical records.
The success rates of FCSEMS placement and removal were 99.3 % and 98.2 %, respectively. Stricture resolution occurred in 103/132 (78.0 %) of the patients (median stent duration, 93 days; range 1 - 489). The associated factors for stricture resolution were longer stent indwelling period (≥ 120 days) and absence of stent migration. Stricture recurrence was seen in 26/103 patients (25.2 %; 95 % confidence interval [CI] 0.17 - 0.34) within a median of 390 days (range 4 - 903 days). Chronic pancreatitis was associated with stricture recurrence (hazard ratio [HR] 2.59, 95 %CI 1.20 - 5.61; P = 0.02). Stent migration occurred in 41/132 patients (31.1 %; 95 %CI 0.23 - 0.39). The FCSEMS with anchoring flaps appeared to protect against stent migration (HR 0.22, 95 %CI 0.08 - 0.63; P < 0.01).
FCSEMSs had a high success rate for BBS resolution. Longer indwelling periods and the absence of stent migration might be important factors for stricture resolution.
全覆膜自膨式金属支架（FCSEMS）是治疗良性胆管狭窄（BBS）的可接受工具。然而，关于该技术的长期疗效知之甚少。本研究的目的是评估FCSEMS治疗BBS的操作及长期疗效。
回顾性分析134例连续性BBS患者（中位年龄56岁；范围21 - 83岁）。主要结局指标为技术成功与临床成功、狭窄缓解、复发及不良事件。通过查阅患者病历分析结局。
FCSEMS置入成功率和取出成功率分别为99.3%和98.2%。103/132例（78.0%）患者狭窄缓解（中位支架留置时间93天；范围1 - 489天）。狭窄缓解的相关因素为较长的支架留置期（≥120天）及无支架移位。26/103例患者（25.2%；95%置信区间[CI] 0.17 - 0.34）在中位时间390天（范围4 - 903天）内出现狭窄复发。慢性胰腺炎与狭窄复发相关（风险比[HR] 2.59，95%CI 1.20 - 5.61；P = 0.02）。41/132例患者（31.1%；95%CI 0.23 - 0.39）发生支架移位。带锚定瓣的FCSEMS似乎可防止支架移位（HR 0.22，95%CI 0.08 - 0.63；P < 0.01）。
FCSEMS治疗BBS成功率高。较长的留置期及无支架移位可能是狭窄缓解的重要因素。
