Takahashi Koji, Tsuyuguchi Toshio, Saiga Atsushi, Horikoshi Takuro, Ooka Yoshihiko, Sugiyama Harutoshi, Nakamura Masato, Kumagai Junichiro, Yamato Mutsumi, Iino Yotaro, Shingyoji Ayako, Ohyama Hiroshi, Yasui Shin, Mikata Rintaro, Sakai Yuji, Kato Naoya
Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan.
Department of Radiology, Graduate School of Medicine, Chiba University, Chiba, Japan.
Oncotarget. 2018 Jun 15;9(46):28185-28194. doi: 10.18632/oncotarget.25598.
In this study, we assessed the factors contributing to ineffective drainage in the initial transpapillary uncovered self-expandable metal stent (USEMS) placements in patients with unresectable malignant hilar biliary strictures (UMHBSs) (Bismuth type II or higher).
This was a retrospective, single-center study. A total of 97 patients with UMHBSs who underwent technically successful initial USEMS placements using endoscopic retrograde cholangiopancreatography (ERCP) were classified into the effective drainage group (n = 73) or the ineffective drainage group (n = 24). We then compared group characteristics, clinical outcomes, and drained liver volumes. Drained liver volume was measured by using computed tomography volumetry. The definition of effective biliary drainage was a 50% decrease in the serum total bilirubin level or normalization of the level within 14 days of stent placement.
Univariate analysis showed that ineffective drainage was associated with the pre-ERCP serum total bilirubin level ( = 0.0075), pre-ERCP serum albumin level ( = 0.042), comorbid liver cirrhosis ( = 0.010), drained liver volume ( = 0.0010), and single stenting ( = 0.022). Multivariate analysis identified comorbid liver cirrhosis (adjusted odds ratio [OR], 5.79; 95% confidence interval [CI], 1.30-25.85; = 0.022) and drained liver volume < 50% (adjusted OR, 5.50; 95% CI, 1.50-20.25; = 0.010) as independent risk factors of ineffective drainage.
Comorbid liver cirrhosis and a drained liver volume < 50% contributed significantly to ineffective drainage in the initial transpapillary USEMS placements for UMHBSs.
在本研究中，我们评估了不可切除的恶性肝门部胆管狭窄（UMHBSs，Bismuth II型或更高分型）患者初次经乳头置入未覆盖的自膨式金属支架（USEMS）时导致引流无效的因素。
这是一项回顾性单中心研究。共有97例UMHBSs患者经内镜逆行胰胆管造影术（ERCP）技术成功完成初次USEMS置入，被分为有效引流组（n = 73）和无效引流组（n = 24）。然后我们比较了两组的特征、临床结局和引流肝体积。引流肝体积通过计算机断层扫描容积测量法测定。有效胆汁引流的定义为支架置入后14天内血清总胆红素水平降低50%或恢复正常。
单因素分析显示，引流无效与ERCP术前血清总胆红素水平（P = 0.0075）、ERCP术前血清白蛋白水平（P = 0.042）、合并肝硬化（P = 0.010）、引流肝体积（P = 0.0010）和单支架置入（P = 0.022）有关。多因素分析确定合并肝硬化（校正比值比[OR]，5.79；95%置信区间[CI]，1.30 - 25.85；P = 0.022）和引流肝体积< 50%（校正OR，5.50；95% CI，1.50 - 20.25；P = 0.010）是引流无效的独立危险因素。
合并肝硬化和引流肝体积< 50%是UMHBSs患者初次经乳头置入USEMS时引流无效的重要因素。
