Kubesch Alica, Görnert Fabian, Filmann Natalie, Bojunga Jörg, Zeuzem Stefan, Jung Michael, Friedrich-Rust Mireen, Walter Dirk
Department of Internal Medicine I, Johann Wolfgang Goethe University Hospital, Frankfurt, Germany.
Institute of Biostatistics and Mathematical Modeling, Johann Wolfgang Goethe University, Frankfurt, Germany.
J Gastroenterol Hepatol. 2022 Jun;37(6):1076-1082. doi: 10.1111/jgh.15824. Epub 2022 Mar 17.
The main disadvantage of plastic stents is the high rate of stent occlusion. The usual replacement interval of biliary plastic stents is 3 months. This study aimed to investigate if a shorter interval of 6-8 weeks impacts the median premature exchange rate (mPER) in benign and malignant biliary strictures.
All cases with endoscopic retrograde cholangiopancreatography (ERCP) and plastic stent placement were retrospectively analyzed since establishing an elective replacement interval of every 6-8 weeks at our institution and mPER was determined.
A total of 3979 ERCPs (1199 patients) were analyzed, including 1262 (31.7%) malignant and 2717 (68.3%) benign cases, respectively. The median stent patency (mSP) was 41 days (range 14-120) for scheduled stent exchanges, whereas it was 17 days (1-75) for prematurely exchanged stents. The mPER was significantly higher for malignant (28.1%, 35-50%) compared with benign strictures (15.2%, 10-28%), P < 0.0001, respectively. mSP was significantly shorter in cases with only one stent (34 days [1-87] vs 41 days [1-120]) and in cases with only a 7-Fr stent (28 days [2-79]) compared with a larger stent (34 days [1-87], P = 0.001). Correspondingly, mPER was significantly higher in cases with only one stent (23% vs 16.2%, P < 0.0001) and only a 7-Fr stent (31.3% vs 22.4%, P = 0.03).
A shorter replacement interval does not seem to lead to a clinically meaningful reduction of mPER in benign and malignant strictures. Large stents and multiple stenting should be favored as possible.
塑料支架的主要缺点是支架闭塞率高。胆管塑料支架的常规更换间隔为3个月。本研究旨在探讨6 - 8周的较短间隔是否会影响良性和恶性胆管狭窄的中位过早更换率（mPER）。
自本机构确定每6 - 8周进行一次选择性更换间隔以来，对所有接受内镜逆行胰胆管造影（ERCP）及放置塑料支架的病例进行回顾性分析，并确定mPER。
共分析了3979例ERCP（1199例患者），其中恶性病例1262例（31.7%），良性病例2717例（68.3%）。计划内支架更换的中位支架通畅时间（mSP）为41天（范围14 - 120天），而过早更换支架的mSP为17天（1 - 75天）。与良性狭窄（15.2%，10 - 28%）相比，恶性狭窄的mPER显著更高（28.1%，35 - 50%），P < 0.0001。与较大支架（34天[1 - 87天]）相比，仅放置一个支架的病例（34天[1 - 87天] vs 41天[1 - 120天]）以及仅放置7Fr支架的病例（28天[2 - 79天]）的mSP显著更短，P = 0.001。相应地，仅放置一个支架的病例（23% vs 16.2%，P < 0.0001）和仅放置7Fr支架的病例（31.3% vs 22.4%，P = 0.03）的mPER显著更高。
较短的更换间隔似乎并不会导致良性和恶性狭窄的mPER出现具有临床意义的降低。应尽可能选用大支架和多支架置入。
