Takeda Tsuyoshi, Sasaki Takashi, Yamada Yuto, Okamoto Takeshi, Mie Takafumi, Furukawa Takaaki, Kasuga Akiyoshi, Matsuyama Masato, Ozaka Masato, Sasahira Naoki
Department of Hepato-Biliary-Pancreatic Medicine Cancer Institute Hospital of Japanese Foundation for Cancer Research Tokyo Japan.
Department of Internal medicine Division of Gastroenterology and Hepatology Toho University Tokyo Japan.
DEN Open. 2023 Jan 9;3(1):e205. doi: 10.1002/deo2.205. eCollection 2023 Apr.
The usefulness of duckbill-type anti-reflux metal stent (DMS) in self-expandable metal stent-naïve pancreatic cancer (PC) patients has not been well-studied. This study aimed to evaluate the efficacy and safety of DMS in such patients.
We analyzed consecutive patients with unresectable PC who received a covered metal stent (CMS) as the initial self-expandable metal stent at our institution. Technical success, functional success, causes of recurrent biliary obstruction (RBO), time to RBO (TRBO), adverse events (AEs), and reintervention rates were compared between DMS and conventional CMS (c-CMS).
A total of 69 patients were included (DMS: 28, c-CMS: 41). Technical success, functional success, and AEs were similar between groups. Tumor ingrowth was more common in the DMS group (18% vs. 0%, = 0.009), while non-occlusion cholangitis tended to be more common in the c-CMS group (0% vs. 15%, = 0.074). Median time to RBO was similar between groups (276 vs. 273 days, = 0.915). The anti-reflux valve of DMS was found torn in 56% of patients. Endoscopic reintervention was successful in all cases, despite failed stent removal in 88% of patients in the DMS group.
DMS was not associated with longer time to RBO compared to c-CMS in self-expandable metal stent-naïve patients.
鸭嘴型抗反流金属支架（DMS）在未使用过自膨式金属支架的胰腺癌（PC）患者中的应用效果尚未得到充分研究。本研究旨在评估DMS在此类患者中的疗效和安全性。
我们分析了在我院接受覆膜金属支架（CMS）作为初始自膨式金属支架的不可切除PC连续患者。比较了DMS和传统CMS（c-CMS）之间的技术成功率、功能成功率、复发性胆管梗阻（RBO）的原因、RBO发生时间（TRBO）、不良事件（AE）和再次干预率。
共纳入69例患者（DMS组：28例，c-CMS组：41例）。两组之间的技术成功率、功能成功率和AE相似。肿瘤长入在DMS组更常见（18%对0%，P = 0.009），而非闭塞性胆管炎在c-CMS组往往更常见（0%对15%，P = 0.074）。两组之间RBO的中位时间相似（276天对273天，P = 0.915）。发现56%的患者DMS抗反流瓣膜撕裂。尽管DMS组88%的患者支架取出失败，但所有病例的内镜再次干预均成功。
在未使用过自膨式金属支架的患者中，与c-CMS相比，DMS与RBO发生时间延长无关。
