Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8655, Japan.
Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8655, Japan.
Dig Dis Sci. 2020 Dec;65(12):3710-3718. doi: 10.1007/s10620-020-06155-z. Epub 2020 Feb 27.
In patients with unresectable hilar malignant biliary obstruction (MBO), bilateral metal stent placement is recommended. However, treatment selection between partially stent-in-stent (SIS) and side-by-side (SBS) methods is still controversial.
Clinical outcomes of bilateral metal stent placement by SBS and SIS methods for hilar MBO were retrospectively studied in four Japanese centers. While large-cell-type uncovered metal stents were placed above the papilla in SIS, braided-type uncovered metal stents were placed across the papilla in SBS.
A total of 64 patients with hilar MBO (40 SIS and 24 SBS) were included in the analysis. Technical success rate was 100% in SIS and 96% in SBS. Functional success rate was 93% in SIS and 96% in SBS. Early adverse event rates were higher in SBS (46%) than in SIS (23%), though not statistically significant (P = 0.09). Post-procedure pancreatitis was exclusively observed in SBS group (29%). Recurrent biliary obstruction rates were 48% and 43%, and the median time to recurrent biliary obstruction was 169 and 205 days in SIS and SBS, respectively.
Other than a trend to higher adverse event rates including post-procedure pancreatitis in SBS, clinical outcomes of SIS and SBS methods were comparable in patients with unresectable hilar MBO.
对于无法切除的肝门恶性胆道梗阻（MBO）患者，推荐放置双侧金属支架。然而，对于部分支架内支架（SIS）和并列（SBS）方法的治疗选择仍存在争议。
在四个日本中心，回顾性研究了 SBS 和 SIS 方法双侧金属支架置入治疗肝门 MBO 的临床结果。在 SIS 中，大细胞型 uncovered 金属支架放置在乳头上方，而在 SBS 中，编织型 uncovered 金属支架放置在乳头两侧。
共纳入 64 例肝门 MBO 患者（40 例 SIS 和 24 例 SBS）。SIS 的技术成功率为 100%，SBS 的技术成功率为 96%。SIS 的功能成功率为 93%，SBS 的功能成功率为 96%。SBS 的早期不良事件发生率（46%）高于 SIS（23%），但无统计学意义（P=0.09）。SBS 组仅观察到术后胰腺炎（29%）。复发性胆道梗阻率分别为 48%和 43%，SIS 和 SBS 的中位复发性胆道梗阻时间分别为 169 和 205 天。
除了 SBS 组术后胰腺炎等不良事件发生率较高的趋势外，SBS 和 SIS 方法治疗不可切除的肝门 MBO 患者的临床结果相当。
