Azienda Ospedaliero-Universitaria di Modena Policlinico di Modena, Viale Giardini 1355, 41126, Modena, Italy.
Surg Endosc. 2022 Aug;36(8):5684-5691. doi: 10.1007/s00464-021-08919-8. Epub 2022 Jan 7.
The management of difficult lithiasis of common bile duct (CBD) often requires a multimodal approach. Fully Covered Metal Stents (FCSEMS) could fragment the stones, dilate strictures of the CBD and progressively enlarge the papillary orifice. The aim of the study was to evaluate the efficacy of FCSEMS in the treatment of difficult lithiasis of CBD.
All consecutive cases of difficult lithiasis of CBD after an attempt of clearance with complete sphincterotomy were retrospectively considered from 2009 to 2019. Intrahepatic lithiasis cases were excluded. Multivariable analysis (stepwise logistic regression if p value < 0.1 at univariable analysis) was made to understand factors associated with efficacy of FCSEMS in difficult lithiasis of CBD.
163 cases of difficult lithiasis over 1516 cases of lithiasis of CBD (incidence of 11%) were considered. Among eligible patients, 96 (mean age 78 ± 11.9 years, 43% males) placed a FCSEMS during the first ERCP. Mean diameter of stone was 17.5 ± 5.5 mm. An attempt of dilation during the same procedure was made in 18% cases. After removal of the stent, 52 (54%) patients had complete clearance of CBD at cholangiography. The rest of patients (44), subsequently underwent multimodal treatment (final success of 95%). After logistic regression, variables positively associated with clearance of CBD were sex male (OR 3.5) and stent permanence ≥ 30 days (OR 3.2). Diameter of the stone ≥ 2 cm was associated with failure (OR 0.2). 7 post-ERCP pancreatitis, 6 post-sphincterotomy bleeding and 3 cholangitis occurred.
FCSEMS are useful in the approach of difficult lithiasis of CBD with no significant adverse events associated.
胆总管（CBD）困难性结石的治疗通常需要采用多模式方法。全覆膜金属支架（FCSEMS）可以使结石碎裂，并扩张 CBD 狭窄段，逐渐扩大乳头开口。本研究旨在评估 FCSEMS 治疗胆总管困难性结石的疗效。
回顾性分析 2009 年至 2019 年期间，在完全括约肌切开术尝试清除后，所有连续出现的胆总管困难性结石病例。排除肝内结石病例。采用多变量分析（单变量分析中 p 值<0.1 时采用逐步逻辑回归），以了解 FCSEMS 治疗胆总管困难性结石的疗效相关因素。
163 例胆总管困难性结石病例（1516 例 CBD 结石中的发生率为 11%）被纳入研究。在合格患者中，96 例（平均年龄 78±11.9 岁，43%为男性）在首次 ERCP 期间放置了 FCSEMS。结石平均直径为 17.5±5.5mm。18%的病例在同一手术中尝试进行扩张。支架取出后，52 例（54%）患者在胆管造影时 CBD 完全清除。其余患者（44 例）随后接受了多模式治疗（最终成功率为 95%）。经过逻辑回归，与 CBD 清除相关的变量为男性（OR 3.5）和支架留置时间≥30 天（OR 3.2）。结石直径≥2cm 与失败相关（OR 0.2）。术后发生 7 例胰腺炎、6 例括约肌切开术后出血和 3 例胆管炎。
FCSEMS 在治疗胆总管困难性结石方面是有用的，且无明显不良事件发生。
