Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, South Korea.
Biostatistics Collaboration Team, National Cancer Center, Goyang, South Korea.
Endoscopy. 2023 Jun;55(6):563-568. doi: 10.1055/a-2013-2034. Epub 2023 Feb 3.
Fully covered self-expandable metal stents (FCSEMSs) are widely used for endoscopic treatment of distal malignant biliary obstruction (dMBO). We aimed to assess the efficacy of anchoring an external plastic stent to an FCSEMS in dMBO. METHODS : A multicenter retrospective cohort study was performed in patients with dMBO to compare stent patency between FCSEMSs and FCSEMSs with an externally anchored plastic stent (EPS). For external anchoring, a 7-Fr double-pigtail plastic stent (DPPS) was placed first in the bile duct, then an FCSEMS was deployed side-by-side. RESULTS : Among a total of 185 patients, 65 had an FCSEMS alone and 120 had an FCSEMS with an EPS. The median stent patency was significantly longer in the FCSEMS with an EPS group than in the FCSEMS only group (342 vs. 240 days; = 0.04). The rate of stent migration was significantly lower in the FCSEMS with an EPS group than in the FCSEMS only group (10.8 % vs. 27.7 %; = 0.01). There were no significant differences in the rates of stent occlusion and adverse events between the two groups. CONCLUSIONS : A novel and simple technique of anchoring an external plastic stent may decrease the risk of FCSEMS migration and prolong stent patency, without significantly increasing the adverse events rate in dMBO.
全覆膜自膨式金属支架（FCSEMS）广泛用于治疗远端恶性胆道梗阻（dMBO）的内镜治疗。本研究旨在评估在 dMBO 中将外部塑料支架锚定到 FCSEMS 的疗效。
对 dMBO 患者进行了一项多中心回顾性队列研究，比较了 FCSEMS 和 FCSEMS 联合外部锚定塑料支架（EPS）的支架通畅率。外部锚定采用 7Fr 双猪尾塑料支架（DPPS）首先置于胆管内，然后并排放置 FCSEMS。
总共 185 例患者中，65 例单独使用 FCSEMS，120 例使用 FCSEMS 联合 EPS。EPS 组 FCSEMS 通畅时间明显长于 FCSEMS 单独组（342 天 vs. 240 天；=0.04）。EPS 组 FCSEMS 迁移率明显低于 FCSEMS 单独组（10.8% vs. 27.7%；=0.01）。两组支架闭塞和不良事件发生率无显著差异。
在 dMBO 中，将外部塑料支架锚定到 FCSEMS 的新技术可能降低 FCSEMS 迁移的风险并延长支架通畅时间，而不会显著增加不良事件的发生率。
