Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Catalonia, Spain.
Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, CIBERehd, Terrassa, Spain.
Surg Endosc. 2021 Aug;35(8):4873-4881. doi: 10.1007/s00464-021-08435-9. Epub 2021 Mar 15.
There are uncertainties concerning the possible benefits derived from the insertion of double-pigtail plastic stents (DPS) within lumen-apposing metal stents (LAMS) in EUS-guided choledochoduodenostomy (CDS). The aim of this study was to determine whether a DPS within a biliary LAMS offers a potential benefit in EUS-guided CDS for the palliative management of malignant biliary obstruction.
This was a multicentre retrospective study at three tertiary institutions.
May 2015 to August 2020. Two interventional strategies (LAMS alone and LAMS plus DPS) were compared. The choice was the endoscopist's discretion. Inclusion: unresectable/inoperable biliopancreatic tumours with previous failed ERCP. Clinical success: bilirubin decrease > 30% at 4 weeks.
Forty-one consecutive cases of EUS-CDS using biliary LAMS were treated (22 women; mean age, 72.3 years) during the study period. The procedure was technically successful in 39 (95.1%), who were managed using the two strategies (22 LAMS alone; 17 LAMS plus DPS). No differences between the groups, in terms of clinical success (77.3 vs 87.5%, p = 0.67), adverse events (AEs, 13.6 vs 11.8%, p = 0.99), recurrent biliary obstruction (RBO, 13.6 vs 23.5%, p = 0.67), or survival rate (p = 0.67) were encountered. The LAMS alone group had a shorter length of procedure (50 min vs 66 min, p = 0.102). No risk factors related to clinical success, AEs, RBO, or survival were detected.
The technical variant of adding a coaxial DPS within LAMS in EUS-CDS seems not to be enough to prevent biliary morbidities, and it is a time-consuming strategy. Although prospective studies are needed, these results do not support its routine use.
在超声内镜引导下胆肠吻合术（EUS-CDS）中，胆管金属支架（LAMS）内插入双猪尾塑料支架（DPS）可能带来的益处尚不确定。本研究旨在确定在 EUS-CDS 中使用胆道 LAMS 内的 DPS 是否可以为恶性胆道梗阻的姑息性治疗带来潜在益处。
这是在三家三级医院进行的多中心回顾性研究。
2015 年 5 月至 2020 年 8 月。比较了两种介入策略（单独使用 LAMS 和 LAMS 加 DPS）。选择由内镜医生决定。纳入标准：先前 ERCP 失败的不可切除/不可手术的胰胆管肿瘤。临床成功：4 周时胆红素下降>30%。
研究期间，共 41 例 EUS-CDS 采用胆道 LAMS 治疗（22 例女性；平均年龄 72.3 岁）。该操作在 39 例（95.1%）中取得技术成功，这 39 例分别采用两种策略进行管理（单独使用 LAMS 22 例；LAMS 加 DPS 17 例）。两组在临床成功率（77.3% vs 87.5%，p=0.67）、不良事件（AE，13.6% vs 11.8%，p=0.99）、复发性胆道梗阻（RBO，13.6% vs 23.5%，p=0.67）或生存率（p=0.67）方面无差异。单独使用 LAMS 组的手术时间更短（50 分钟 vs 66 分钟，p=0.102）。未发现与临床成功率、AE、RBO 或生存率相关的危险因素。
在 EUS-CDS 中，在 LAMS 内添加同轴 DPS 的技术变体似乎不足以预防胆道并发症，而且这是一种耗时的策略。尽管需要前瞻性研究，但这些结果并不支持其常规使用。
