Mangiavillano Benedetto, Kunda Rastislav, Robles-Medranda Carlos, Oleas Roberto, Anderloni Andrea, Sportes Adrien, Fabbri Carlo, Binda Cecilia, Auriemma Francesco, Eusebi Leonardo H, Frazzoni Leonardo, Fuccio Lorenzo, Colombo Matteo, Fugazza Alessandro, Bianchetti Mario, Repici Alessandro
Gastrointestinal Endoscopy Unit - Humanitas Mater Domini - Castellanza (VA), Italy.
Humanitas University, Pieve Emanuele (MI), Italy.
Endosc Int Open. 2021 Mar;9(3):E324-E330. doi: 10.1055/a-1333-1053. Epub 2021 Feb 18.
Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard procedure for malignant jaundice palliation; however, it can be challenging when a duodenal self-expandable metal stent (SEMS) is already in place. The primary aim of our study was to evaluate the technical feasibility of the placement of a lumen apposing metal stent (LAMS) through the mesh (TTM) of duodenal stents. The secondary aims were to evaluate clinical outcomes and adverse events (AEs) related to the procedures. Data from 23 patients (11 F and 12 M; mean age: 69.5 ± 11 years old) were collected. In 17 patients (73.9 %) TTM LAMS placement was performed as first intention, while in six patients (26.1 %) it was performed after a failed ERCP. Thirteen patients (56.5 %) underwent the procedure due to advanced pancreatic head neoplasia. One technical failure was experienced (4.3 %). The TTM LAMS placement led to a significant decrease in the serum levels of bilirubin, ALP, GGT, WBC and CRP. No cases of duodenal SEMS occlusion occurred and no other AEs were observed during the follow-up. Concomitant malignant duodenal and biliary obstruction is a challenging condition. Palliation of jaundice using TTM LAMS in patients already treated with duodenal stent is associated to promising technical and clinical outcomes.
内镜逆行胰胆管造影术（ERCP）是恶性黄疸姑息治疗的金标准手术；然而，当十二指肠自膨式金属支架（SEMS）已经置入时，该手术可能具有挑战性。我们研究的主要目的是评估通过十二指肠支架网孔（TTM）置入管腔贴附金属支架（LAMS）的技术可行性。次要目的是评估与手术相关的临床结果和不良事件（AE）。收集了23例患者（11例女性和12例男性；平均年龄：69.5±11岁）的数据。17例患者（73.9%）首次尝试进行TTM LAMS置入，而6例患者（26.1%）在ERCP失败后进行。13例患者（56.5%）因晚期胰头肿瘤接受该手术。发生了1例技术失败（4.3%）。TTM LAMS置入导致血清胆红素、碱性磷酸酶、γ-谷氨酰转移酶、白细胞和C反应蛋白水平显著降低。随访期间未发生十二指肠SEMS阻塞病例，也未观察到其他不良事件。同时存在的恶性十二指肠和胆管梗阻是一种具有挑战性的情况。在已接受十二指肠支架治疗的患者中使用TTM LAMS缓解黄疸与良好的技术和临床结果相关。
