Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Republic of Korea.
Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Saudi J Gastroenterol. 2021 May-Jun;27(3):173-177. doi: 10.4103/sjg.sjg_589_20.
Malignant biliary obstruction (MBO) is usually caused by biliary tract cancer or pancreatic cancer. This study was performed to summarize the current situation regarding palliative endoscopic retrograde biliary drainage (ERBD) for MBO in Korea and to determine its clinical significance by analyzing representative nationwide data.
Patients that underwent palliative ERBD for MBO between 2012 and 2015 were identified using the Health Insurance Review and Assessment database, which covers the entire Korean population. We assessed clinical characteristics and complications and compared the clinical impacts of initial metal and plastic stenting in these patients.
A total of 9,728 subjects (mean age, 65 ± 11.4 years; male, 61.4%) were identified and analyzed. The most common diagnosis was malignant neoplasm of liver and intrahepatic bile ducts (32.1%) and this was followed by extrahepatic or Ampulla of Vater cancer and pancreatic cancer. Initial plastic stent(s) placement was performed in 52.9% of the study subjects, and metal stent(s) placement was performed in 23.3%. The number of sessions of endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic biliary drainage (PTBD) was significantly higher in patients that underwent initial plastic stenting than in patients that underwent metal stenting (2.2 ± 1.7 vs 1.8 ± 1.4, P < 0.0001), but rates of post-ERCP pancreatitis, hospital days, and time to second ERCP or PTBD were not significantly different.
This nationwide assessment study suggests that initial metal stenting is associated with fewer sessions of total ERCP or PTBD following the initial procedure, despite the preference for initial plastic stenting in Korea.
恶性胆道梗阻（MBO）通常由胆道癌或胰腺癌引起。本研究旨在总结韩国姑息性内镜逆行胆道引流（ERBD）治疗 MBO 的现状，并通过分析具有代表性的全国性数据来确定其临床意义。
使用涵盖整个韩国人口的健康保险审查和评估数据库，确定 2012 年至 2015 年间接受姑息性 ERBD 治疗 MBO 的患者。我们评估了临床特征和并发症，并比较了这些患者初次金属和塑料支架置入的临床影响。
共纳入 9728 例患者（平均年龄 65 ± 11.4 岁；男性占 61.4%）进行分析。最常见的诊断是肝内和肝内胆管恶性肿瘤（32.1%），其次是肝外或壶腹癌和胰腺癌。研究对象中 52.9%初次行塑料支架置入，23.3%初次行金属支架置入。初次行塑料支架置入的患者行内镜逆行胰胆管造影（ERCP）或经皮经肝胆道引流（PTBD）的次数明显多于初次行金属支架置入的患者（2.2 ± 1.7 比 1.8 ± 1.4，P < 0.0001），但 ERCP 后胰腺炎、住院天数以及行第二次 ERCP 或 PTBD 的时间并无显著差异。
本项全国性评估研究表明，尽管韩国更倾向于初次行塑料支架置入，但初次金属支架置入与初次操作后总 ERCP 或 PTBD 的次数较少相关。
