Zhu Zhenhua, Li Biming, Liao Wangdi, Lv Nonghua, Chen Youxiang, Shu Xu
Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China.
Front Oncol. 2020 May 13;10:637. doi: 10.3389/fonc.2020.00637. eCollection 2020.
This study aimed to identify risk factors related to guidewire insertion (GWI) failure and construct a novel predictive nomogram. In addition, sphincterotome-assisted guidewire insertion (SAGWI) in difficult cases was evaluated for efficacy and safety. We reviewed the data of 509 patients with malignant colorectal obstruction who underwent endoscopic self-expandable metal stent (SEMS) insertion from 2007 to 2018 in our center, retrospectively. We identify risk factors associated with GWI failure by multivariate logistic regression analysis and construct a novel predictive nomogram. Improvements in the GWI and technical and clinical success rates were assessed for the SAGWI technique. A total of 509 patients with malignant colorectal obstruction were included. Increases of 6.9% and 7.0% were found in the GWI success rate by intention-to-treat (ITT; < 0.001) and per-protocol (PP; < 0.001) analyses after SAGWI, respectively. Increases of 6.5% and 6.6% in the technical success rate were found by ITT ( < 0.001) and PP ( < 0.001) analyses after SAGWI, respectively. Increases of 5.8% and 6.0% in the clinical success rate were found by ITT ( < 0.001) and PP ( < 0.001) analyses after SAGWI, respectively. Regarding the GWI failure-related factors, a sharply angulated stricture was an independent risk factor, and an experienced colonoscopist was an independent protective factor. A novel effective predictive nomogram was constructed. The novel predictive nomogram can be conveniently used to identify difficult cases. A sharply angulated stricture and an experienced colonoscopist are independent factors related to GWI failure. The SAGWI technique is an effective and safe method for addressing technically difficult cases.
本研究旨在确定与导丝插入（GWI）失败相关的危险因素，并构建一种新型预测列线图。此外，还评估了在困难病例中括约肌切开刀辅助导丝插入（SAGWI）的有效性和安全性。我们回顾性分析了2007年至2018年在本中心接受内镜下自膨式金属支架（SEMS）置入的509例恶性大肠梗阻患者的数据。通过多因素逻辑回归分析确定与GWI失败相关的危险因素，并构建新型预测列线图。评估了SAGWI技术在GWI以及技术和临床成功率方面的改善情况。共纳入509例恶性大肠梗阻患者。SAGWI术后意向性治疗（ITT；<0.001）和符合方案（PP；<0.001）分析显示，GWI成功率分别提高了6.9%和7.0%。SAGWI术后ITT（<0.001）和PP（<0.001）分析显示，技术成功率分别提高了6.5%和6.6%。SAGWI术后ITT（<0.001）和PP（<0.001）分析显示，临床成功率分别提高了5.8%和6.0%。关于GWI失败相关因素，锐角狭窄是独立危险因素，经验丰富的结肠镜检查医师是独立保护因素。构建了一种新型有效预测列线图。该新型预测列线图可方便地用于识别困难病例。锐角狭窄和经验丰富的结肠镜检查医师是与GWI失败相关的独立因素。SAGWI技术是处理技术上困难病例的一种有效且安全的方法。
