Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran.
Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran.
Dig Dis Sci. 2022 Jan;67(1):315-320. doi: 10.1007/s10620-021-06904-8. Epub 2021 Mar 20.
In patients with severe biliary pancreatitis, delayed cholecystectomy associated with a high risk of recurrence is recommended. The current study aimed to evaluate the effect of common bile duct (CBD) stenting on reducing gallstones migration and recurrence of symptoms in patients with pancreatitis and delayed cholecystectomy candidates.
To this purpose, the randomized, controlled clinical trial was performed on 40 patients with biliary pancreatitis who were candidates for delayed cholecystectomy. Patients were randomly divided into two groups of A and B that underwent CBD stenting after ERCP and received endoscopic treatment without stenting, respectively. A checklist recorded demographics and complications. Group A was followed up after four weeks to remove the stent and record the complications. Group B underwent MRCP to examine the migration of new gallstones as well as the complications.
Of the 40 patients, 20 subjects (11 males and 9 females) were allocated to each group, matched for demographic variables. In the one-month follow-up, only one subject in group A manifested symptoms of gallstone migration and recurrence, while in group B, recurrence was observed in 6 patients (P = 0.037). There was no significant difference in the success rate of ERCP and the incidence of complications between the two groups.
CBD stenting in patients with biliary pancreatitis and gallstone could reduce the risk of recurrence and remigration of gallstones in delayed cholecystectomy cases.
对于重症胆源性胰腺炎患者,建议延迟胆囊切除术并伴有较高的复发风险。本研究旨在评估胆总管(CBD)支架置入术对降低胰腺炎和延迟胆囊切除术患者胆石迁移和症状复发的影响。
为此,对 40 例有胆源性胰腺炎且适合延迟胆囊切除术的患者进行了随机对照临床试验。患者随机分为两组,A 组在 ERCP 后行 CBD 支架置入,并进行内镜治疗,B 组则不进行支架置入。检查表记录了人口统计学和并发症。A 组在四周后随访以取出支架并记录并发症。B 组行 MRCP 检查新胆石的迁移以及并发症。
40 例患者中,20 例(11 例男性和 9 例女性)被平均分配到每组,在人口统计学变量方面相匹配。在一个月的随访中,只有 A 组的 1 例患者出现胆石迁移和复发的症状,而 B 组有 6 例患者复发(P=0.037)。两组的 ERCP 成功率和并发症发生率无显著差异。
CBD 支架置入术可降低胆源性胰腺炎和胆囊结石患者延迟胆囊切除术后胆石复发和再迁移的风险。