Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Republic of Korea.
Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
J Gastroenterol Hepatol. 2020 Dec;35(12):2248-2255. doi: 10.1111/jgh.15123. Epub 2020 Jun 17.
Multiple insertions of self-expandable metal stents (SEMS) for advanced malignant hilar obstruction (MHO) are now considered to be an effective palliative method for adequate drainage of liver volume. However, the efficacy of endoscopic reintervention in technically and clinically successful bilateral SEMS is limited. This study investigated the endoscopic revision efficacy in patients who underwent bilateral SEMS in MHO.
Primary endoscopic revision using plastic or metal stents or an alternative percutaneous approach followed by secondary endoscopic revision was performed in patients who underwent clinically successful deployment of bilateral SEMS. The primary outcome was a technical success. Secondary outcomes were clinical success, adverse events, and patency duration after reintervention.
A total of 55 patients (83.3%) out of 66 enrolled patients underwent reintervention: primary endoscopic reintervention (n = 47) and secondary endoscopic revision following percutaneous drainage (n = 8). Intended technical success rates of primary and secondary endoscopic reintervention were 93.6% (44/47) and 87.5% (7/8), respectively (P = 0.47). Clinical success rates were 72.3% and 50%, respectively (P = 0.23). Stent malfunction rate after reintervention was 48.9% (23/47) and 37.5% (3/8) (P = 0.70) during follow up, and median cumulative stent patency duration was 119 and 55 days, respectively (log-rank P = 0.68). Stent patent rate after reintervention was not different according to the time interval. In univariate and multivariate analysis for stent patency duration-related factors after reintervention, there were no meaningful factors.
Primary endoscopic reintervention for bilateral SEMS in MHO was feasible technically and clinically. However, there were no statistically meaningful factors for stent patency duration after reintervention.
对于晚期恶性肝门部梗阻（MHO），多枚自膨式金属支架（SEMS）的多次插入现在被认为是充分引流肝脏体积的有效姑息性方法。然而，对于技术上和临床上成功的双侧 SEMS 进行内镜再干预的效果是有限的。本研究调查了 MHO 中接受双侧 SEMS 的患者进行内镜修正的效果。
对接受双侧 SEMS 成功治疗的患者进行原发性内镜修正，使用塑料或金属支架或替代经皮方法，然后进行继发性内镜修正。主要结果是技术上的成功。次要结果是临床成功、不良事件和再干预后的通畅时间。
在 66 名入组患者中，共有 55 名（83.3%）患者接受了再干预：原发性内镜再干预（n=47）和经皮引流后的继发性内镜修正（n=8）。原发性和继发性内镜再干预的预期技术成功率分别为 93.6%（44/47）和 87.5%（7/8）（P=0.47）。临床成功率分别为 72.3%和 50%（P=0.23）。再干预后支架功能障碍的发生率分别为 48.9%（47/47）和 37.5%（8/8）（P=0.70），在随访期间，中位累积支架通畅时间分别为 119 天和 55 天（对数秩 P=0.68）。再干预后支架通畅率与时间间隔无关。在与再干预后支架通畅时间相关因素的单因素和多因素分析中，没有有意义的因素。
对于 MHO 中的双侧 SEMS，原发性内镜再干预在技术上和临床上都是可行的。然而，再干预后支架通畅时间没有统计学意义的因素。
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