Shin Jongbeom, Park Jin-Seok, Jeong Seok, Lee Don Haeng
Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon, 22332, South Korea.
Dig Dis Sci. 2020 Apr;65(4):1231-1238. doi: 10.1007/s10620-019-05859-1. Epub 2019 Oct 4.
To prevent stent migration, transpapillary stent placement has been recommended for the endoscopic treatment of malignant hilar biliary stricture. However, recent studies have suggested that placement above the papilla achieves better results, because it is believed to prevent reflux and prolong stent patency. The aim of this study was to compare the efficacy and safety aspects of transpapillary and suprapapillary stent placement. In addition, the success rates of stent revision were evaluated.
The medical records of 73 patients with hilar cholangiocarcinoma who underwent endoscopic metal stent insertion between January 2005 and December 2015 were retrospectively reviewed. Patients were assigned by stent location to a suprapapillary (S group; N = 44) or a transpapillary (T group; N = 29) cohort. Clinical outcomes, stent patency, adverse events, and revision success rates were compared between the two study groups.
Patency periods were similar in the two groups (S; 140 vs. T; 157 days; P = 0.732). Rates of stent obstruction in the S and T groups were 63.4% and 55.2%, respectively (P = 0.470). An adverse event occurred in 15 (20.5%) of total study subjects, with no significant intergroup difference. The endoscopic revision success rate was significantly higher in the T group (P = 0.01), and the time required for revision tended to be shorter in the T group.
The effectiveness and safety of suprapapillary and transpapillary stent insertion were found to be similar, but the success rate of endoscopic revision was significantly higher for the T group. Therefore, we recommend that transpapillary stent placement be considered for patients with hilar cholangiocarcinoma and biliary obstruction.
为防止支架移位，经乳头置入支架已被推荐用于恶性肝门部胆管狭窄的内镜治疗。然而，近期研究表明，在乳头上方置入支架可取得更好的效果，因为人们认为这样能防止反流并延长支架通畅时间。本研究的目的是比较经乳头和乳头上方支架置入的疗效与安全性。此外，还评估了支架翻修的成功率。
回顾性分析2005年1月至2015年12月期间接受内镜金属支架置入术的73例肝门部胆管癌患者的病历。根据支架位置将患者分为乳头上方组（S组；n = 44）和经乳头组（T组；n = 29）。比较两组的临床结局、支架通畅情况、不良事件及翻修成功率。
两组的通畅时间相似（S组为140天，T组为157天；P = 0.732）。S组和T组的支架阻塞率分别为63.4%和55.2%（P = 0.470）。15例（20.5%）研究对象发生了不良事件，组间差异无统计学意义。T组的内镜翻修成功率显著更高（P = 0.01），且T组翻修所需时间往往更短。
发现乳头上方和经乳头支架置入的有效性和安全性相似，但T组的内镜翻修成功率显著更高。因此，我们建议对肝门部胆管癌合并胆管梗阻的患者考虑行经乳头支架置入。
