Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China.
Department of Gastroenterology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
J Dig Dis. 2020 May;21(5):293-300. doi: 10.1111/1751-2980.12864. Epub 2020 May 11.
To evaluate whether patients with malignant biliary obstruction (MBO) benefit from balloon dilation before the placement of a self-expanding metal stent (SEMS) for palliative biliary drainage.
Consecutive patients who underwent endoscopic retrograde cholangiopancreatography with SEMS placement for palliative management of MBO were retrospectively included. Comparative analyses of serum bilirubin levels, post-procedural adverse events, stent patency time, stent dysfunction, and patient survival were performed between the dilation and non-dilation groups.
A total of 221 patients underwent palliative endoscopic SEMS implantation for MBO from January 2014 to June 2018. Dilation significantly improved the percentage of serum bilirubin improvement (37.0% vs 14.3%, P = 0.001), with a decreasing trend in the incidence of post-procedural cholangitis (2.5% vs 7.8%, P = 0.075), while the rates of other complications such as pancreatitis and bleeding were not increased. The patency time of SEMS and patient survival did not significantly differ between patients with and without dilation. Patients had endoscopic nasobiliary drainage (ENBD) but not dilation showed similar short-term outcomes as patients underwent dilation but without ENBD.
Dilation with a small-caliber balloon catheter before the placement of SEMS is a safe and effective approach for MBO. Balloon dilation may improve the short-term efficacy of SEMS placement, while long-term outcomes are not obviously affected. The short-term effect of stricture dilation may be achieved by ENBD. Further studies are needed to confirm our results.
评估恶性胆道梗阻（MBO）患者在放置自膨式金属支架（SEMS）进行姑息性胆道引流之前行球囊扩张是否获益。
回顾性纳入 2014 年 1 月至 2018 年 6 月期间因 MBO 行内镜逆行胰胆管造影术（ERCP）并置入 SEMS 进行姑息性治疗的连续患者。对扩张组和非扩张组的血清胆红素水平、术后不良事件、支架通畅时间、支架功能障碍和患者生存情况进行比较分析。
共 221 例患者因 MBO 行姑息性内镜 SEMS 植入术。扩张组血清胆红素改善率（37.0%比 14.3%，P=0.001）显著提高，术后胆管炎发生率（2.5%比 7.8%，P=0.075）呈下降趋势，而胰腺炎和出血等其他并发症的发生率并未增加。扩张组和非扩张组 SEMS 通畅时间和患者生存时间无显著差异。行内镜鼻胆管引流（ENBD）而未行扩张组患者与行扩张但未行 ENBD 组患者具有相似的短期结局。
在 SEMS 置入前使用小口径球囊导管扩张是安全有效的 MBO 治疗方法。球囊扩张可能会改善 SEMS 置入的短期疗效，但对长期结局无明显影响。ENBD 可能可以达到狭窄扩张的短期效果。需要进一步的研究来证实我们的结果。
