Jang Dong Kee, Lee Sang Hyub, Ahn Dong Won, Paik Woo Hyun, Lee Jae Min, Lee Jun Kyu, Ryu Ji Kon, Kim Yong-Tae
Department of Internal Medicine, Dongguk University College of Medicine, Dongguk University Ilsan Hospital, Goyang-si, Republic of Korea.
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Endoscopy. 2020 Jun;52(6):462-468. doi: 10.1055/a-1117-3393. Epub 2020 Feb 27.
Although temporary endoscopic biliary stenting is considered effective for difficult common bile duct (CBD) stones, few studies have investigated the optimal conditions for complete stone clearance at the second endoscopic retrograde cholangiopancreatography (ERCP) after temporary biliary stenting. We aimed to evaluate factors associated with complete clearance.
Patients with difficult CBD stones (a large [≥ 20 mm] or multiple [≥ 3 sized ≥ 15 mm] CBD stones) were retrospectively enrolled from three institutions. Patients who underwent temporary biliary stenting at the first ERCP were analyzed. Double-pigtail plastic stents (7 or 10 Fr) were placed with the proximal ends above the stones. Complete clearance rate and stone size reduction at the second ERCP, and factors associated with complete clearance were evaluated using univariate and multivariate analyses.
85 patients were enrolled (mean age 74.5 years [SD 11.3]; 47 women). Stone size and CBD diameter significantly decreased during the interval. The overall complete stone clearance rate was 64.7 % (55/85) at the second ERCP. The mean stone size reduction was 5.6 mm (SD 6.8). In multivariate analysis, complete clearance rate was significantly lower in male patients, in patients aged > 80 years, and in stones > 25 mm initially, but was significantly higher when 7-Fr stents were placed and stone size was reduced by > 5 mm.
Use of 7-Fr rather than 10-Fr plastic stents was beneficial for complete clearance of difficult CBD stones after temporary biliary stenting; older male patients as well as patients with initial stones > 25 mm had a lower clearance rate.
尽管临时内镜下胆道支架置入术被认为对困难性胆总管结石有效，但很少有研究探讨在临时胆道支架置入术后第二次内镜逆行胰胆管造影（ERCP）时实现结石完全清除的最佳条件。我们旨在评估与完全清除相关的因素。
从三个机构回顾性纳入患有困难性胆总管结石（大结石[≥20mm]或多发结石[≥3枚，大小≥15mm]）的患者。对在首次ERCP时接受临时胆道支架置入术的患者进行分析。放置双猪尾塑料支架（7或10Fr），近端置于结石上方。使用单因素和多因素分析评估第二次ERCP时的完全清除率、结石尺寸减小情况以及与完全清除相关的因素。
共纳入85例患者（平均年龄74.5岁[标准差11.3]；47例女性）。在此期间结石大小和胆总管直径显著减小。第二次ERCP时总的结石完全清除率为64.7%（55/85）。结石平均尺寸减小5.6mm（标准差6.8）。在多因素分析中，男性患者、年龄>80岁的患者以及最初结石>25mm的患者完全清除率显著较低，但放置7Fr支架且结石尺寸减小>5mm时完全清除率显著较高。
使用7Fr而非10Fr塑料支架有利于临时胆道支架置入术后困难性胆总管结石的完全清除；老年男性患者以及最初结石>25mm的患者清除率较低。
