Takada Ryoji, Ikezawa Kenji, Kiyota Ryosuke, Imai Toshihiro, Abe Yutaro, Fukutake Nobuyasu, Ashida Reiko, Nawa Takatoshi, Tabuchi Takahiro, Katayama Kazuhiro, Ohkawa Kazuyoshi
Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan.
Department of Cancer Survey and Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.
Endosc Int Open. 2020 Jun;8(6):E753-E760. doi: 10.1055/a-1135-8437. Epub 2020 May 25.
The best method for endoscopic placement of self-expandable metallic stents (SEMS) for distal malignant biliary obstruction (MBO) has not yet been determined. The aim of this study was to evaluate how SEMS placement above the papilla and without endoscopic sphincterotomy (EST) impacts the time to recurrent biliary obstruction (RBO) in patients with distal MBO. We retrospectively reviewed data for 73 consecutive patients with unresectable distal MBO who underwent endoscopic SEMS placement for the first time at our institution between April 2014 and March 2016. We compared time to RBO of SEMS placement above the papilla (intraductal placement) with SEMS placement across the papilla (transpapillary placement). In the intraductal placement group, we also compared time to RBO of placement without EST with placement with EST. Endoscopic SEMS placement was performed in 30 patients with intraductal placement and in 43 patients with transpapillary placement. The median time to RBO was significantly longer with intraductal placement (307 days) than with transpapillary placement (161 days) ( = 0.022). Complication rates did not differ between the two groups. In both univariate and multivariate analysis, intraductal placement was an independent factor contributing to prolonged time to RBO. In intraductal placement, time to RBO was significantly longer in SEMS placement without EST than with EST (363 days vs. 227 days, respectively; = 0.026). Intraductal SEMS placement, especially without EST for distal MBO contributed to longer time to RBO.
对于远端恶性胆管梗阻（MBO）患者，内镜下放置自膨式金属支架（SEMS）的最佳方法尚未确定。本研究的目的是评估在乳头上方且不进行内镜括约肌切开术（EST）的情况下放置SEMS对远端MBO患者复发性胆管梗阻（RBO）时间的影响。我们回顾性分析了2014年4月至2016年3月期间在我院首次接受内镜下SEMS置入术的73例不可切除远端MBO患者的数据。我们比较了乳头上方SEMS置入术（导管内置入）与跨乳头SEMS置入术（经乳头置入）的RBO时间。在导管内置入组中，我们还比较了未行EST的置入术与行EST的置入术的RBO时间。30例患者行导管内SEMS置入术，43例患者行经乳头SEMS置入术。导管内置入术的RBO中位时间（307天）显著长于经乳头置入术（161天）（P = 0.022）。两组并发症发生率无差异。单因素和多因素分析均显示，导管内置入术是导致RBO时间延长的独立因素。在导管内置入术中，未行EST的SEMS置入术的RBO时间显著长于行EST的SEMS置入术（分别为363天和227天；P = 0.026）。导管内SEMS置入术，尤其是对远端MBO未行EST的情况下，可延长RBO时间。
