Morita Shinichi, Arai Yasuaki, Sugawara Shunsuke, Sone Miyuki, Sakamoto Yasunari, Okusaka Takuji, Yoshinaga Shigetaka, Saito Yutaka, Terai Shuji
Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine, Niigata University Hospital, 4132 Urasa, Minamiuonuma, Niigata 949-7302, Japan.
Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
Gastroenterol Res Pract. 2018 Jan 31;2018:3805173. doi: 10.1155/2018/3805173. eCollection 2018.
To compare the use of an antireflux metal stent (ARMS) with that of a conventional covered self-expandable metal stent (c-CSEMS) for initial stenting of malignant distal biliary obstruction (MDBO).
We retrospectively investigated 59 consecutive patients with unresectable MDBO undergoing initial endoscopic biliary drainage. ARMS was used in 32 patients and c-CSEMS in 27. Technical success, functional success, complications, causes of recurrent biliary obstruction (RBO), time to RBO (TRBO), and reintervention were compared between the groups.
Stent placement was technically successful in all patients. There were no significant intergroup differences in functional success (ARMS [96.9%] versus c-CSEMS [96.2%]), complications (6.2 versus 7.4%), and RBO (48.4 versus 42.3%). Food impaction was significantly less frequent for ARMS than for c-CSEMS ( = 0.037), but TRBO did not differ significantly between the groups (log-rank test, = 0.967). The median TRBO was 180.0 [interquartile range (IQR), 114.0-349.0] days for ARMS and 137.0 [IQR, 87.0-442.0] days for c-CSEMS. In both groups, reintervention for RBO was successfully completed in all patients thus treated.
ARMS offers no advantage for initial stent placement, but food impaction is significantly prevented by the antireflux valve.
比较抗反流金属支架（ARMS）与传统覆膜自膨式金属支架（c-CSEMS）在恶性远端胆管梗阻（MDBO）初始支架置入中的应用。
我们回顾性研究了59例连续的不可切除MDBO患者，这些患者接受了初始内镜下胆管引流。32例患者使用ARMS，27例患者使用c-CSEMS。比较两组之间的技术成功率、功能成功率、并发症、复发性胆管梗阻（RBO）的原因、RBO发生时间（TRBO）和再次干预情况。
所有患者支架置入技术均成功。两组在功能成功率（ARMS [96.9%] 对c-CSEMS [96.2%]）、并发症（6.2%对7.4%）和RBO（48.4%对42.3%）方面无显著组间差异。ARMS的食物嵌塞发生率显著低于c-CSEMS（P = 0.037），但两组之间的TRBO无显著差异（对数秩检验，P = 0.967）。ARMS的中位TRBO为180.0 [四分位间距（IQR），114.0 - 349.0] 天，c-CSEMS为137.0 [IQR，87.0 - 442.0] 天。在两组中，所有接受RBO再次干预治疗的患者均成功完成。
ARMS在初始支架置入方面无优势，但抗反流瓣膜可显著预防食物嵌塞。
