Martinez Nichol S, Inamdar Sumant, Firoozan Sheila N, Izard Stephanie, Lee Calvin, Benias Petros C, Trindade Arvind J, Sejpal Divyesh V
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Gastroenterology, Manhasset, New York, United States.
University of Arkansas for Medical Sciences, Gastroenterology, Little Rock, Arkansas, United States.
Endosc Int Open. 2021 Jun;9(6):E888-E894. doi: 10.1055/a-1388-6964. Epub 2021 May 27.
There are conflicting data regarding the risk of post-ERCP pancreatitis (PEP) with self-expandable metallic stents (SEMS) compared to polyethylene stents (PS) in malignant biliary obstructions and limited data related to benign obstructions. A retrospective cohort study was performed of 1136 patients who underwent ERCP for biliary obstruction and received SEMS or PS at a tertiary-care medical center between January 2011 and October 2016. We evaluated the association between stent type (SEMS vs PS) and PEP in malignant and benign biliary obstructions. Among the 1136 patients included in our study, 399 had SEMS placed and 737 had PS placed. Patients with PS were more likely to have pancreatic duct cannulation, pancreatic duct stent placement, double guidewire technique, sphincterotomy and sphincteroplasty as compared to the SEMS group. On multivariate analysis, PEP rates were higher in the SEMS group (8.0 %) versus the PS group (4.8 %) (OR 2.27 [CI, 1.22, 4.24]) for all obstructions. For malignant obstructions, PEP rates were 7.8 % and 6.6 % for SEMS and plastic stents, respectively (OR 1.54 [CI, 0.72, 3.30]). For benign obstructions the PEP rate was higher in the SEMS group (8.8 %) compared to the PS group (4.2 %) (OR 3.67 [CI, 1.50, 8.97]). No significant differences between PEP severity were identified based on stent type when stratified based on benign and malignant. PEP rates were higher when SEMS were used for benign obstruction as compared to PS. For malignant obstruction, no difference was identified in PEP rates with use of SEMS vs PS.
关于在恶性胆道梗阻中，与聚乙烯支架（PS）相比，自膨式金属支架（SEMS）发生内镜逆行胰胆管造影术后胰腺炎（PEP）的风险，存在相互矛盾的数据，而关于良性梗阻的数据有限。对2011年1月至2016年10月期间在一家三级医疗中心因胆道梗阻接受内镜逆行胰胆管造影术并置入SEMS或PS的1136例患者进行了一项回顾性队列研究。我们评估了支架类型（SEMS与PS）与恶性和良性胆道梗阻中PEP之间的关联。在我们纳入研究的1136例患者中，399例置入了SEMS，737例置入了PS。与SEMS组相比，PS组患者更有可能进行胰管插管、胰管支架置入、双导丝技术、括约肌切开术和括约肌成形术。多因素分析显示，所有梗阻患者中，SEMS组的PEP发生率（8.0%）高于PS组（4.8%）（OR 2.27[CI，1.22，4.24]）。对于恶性梗阻，SEMS和塑料支架的PEP发生率分别为7.8%和6.6%（OR 1.54[CI，0.72，3.30]）。对于良性梗阻，SEMS组的PEP发生率（8.8%）高于PS组（4.2%）（OR 3.67[CI，1.50，8.97]）。根据支架类型分层时，无论良性还是恶性，PEP严重程度均无显著差异。与PS相比，使用SEMS治疗良性梗阻时PEP发生率更高。对于恶性梗阻，使用SEMS与PS的PEP发生率未发现差异。
