Digestive Surgery Department, Dupuytren Limoges University Hospital, Limoges, France.
Hepato-Gastroenterology Department, CHU Dupuytren, Limoges, France.
Ann Surg Oncol. 2023 Aug;30(8):5036-5046. doi: 10.1245/s10434-023-13466-8. Epub 2023 Apr 17.
It is unclear whether preoperative biliary drainage (PBD) by endoscopic retrograde cholangiopancreatography (ERCP) is equivalent to electrocautery-enhanced lumen-apposing metal stent (ECE-LAMS) before pancreatoduodenectomy (PD).
Patients who underwent PBD for distal malignant biliary obstruction (DMBO) followed by PD were retrospectively included in nine expert centers between 2015 and 2022. ERCP or endoscopic ultrasound-guided choledochoduodenostomy with ECE-LAMS were performed. In intent-to-treat analysis, patients drained with ECE-LAMS were considered the study group (first-LAMS group) and those drained with conventional transpapillary stent the control group (first-cannulation group). The rates of technical success, clinical success, drainage-related complications, surgical complications, and oncological outcomes were analyzed.
Among 156 patients, 128 underwent ERCP and 28 ECE-LAMS in first intent. The technical and clinical success rates were 83.5% and 70.2% in the first-cannulation group versus 100% and 89.3% in the first-LAMS group (p = 0.02 and p = 0.05, respectively). The overall complication rate over the entire patient journey was 93.7% in first-cannulation group versus 92.0% in first-LAMS group (p = 0.04). The overall endoscopic complication rate was 30.5% in first-cannulation group versus 17.9% in first-LAMS group (p = 0.25). The overall complication rate after PD was higher in the first-cannulation group than in the first-LAMS group (92.2% versus 75.0%, p = 0.016). Overall survival and progression-free survival did not differ between the groups.
PBD with ECE-LAMS is easier to deploy and more efficient than ERCP in patients with DMBO. It is associated with less surgical complications after pancreatoduodenectomy without compromising the oncological outcome.
经内镜逆行胰胆管造影术（ERCP）术前胆道引流（PBD）是否与胰十二指肠切除术（PD）前电烧增强型腔内置管金属支架（ECE-LAMS）相当尚不清楚。
2015 年至 2022 年间，在九个专家中心回顾性纳入了因远端恶性胆道梗阻（DMBO）而行 PBD 后继而行 PD 的患者。行 ERCP 或内镜超声引导下胆管十二指肠吻合术并置入 ECE-LAMS。在意向治疗分析中，使用 ECE-LAMS 引流的患者被视为研究组（第一 LAMS 组），而使用传统经乳头支架引流的患者被视为对照组（第一插管组）。分析技术成功率、临床成功率、引流相关并发症、手术并发症和肿瘤学结果。
在 156 例患者中，128 例行 ERCP，28 例行 ECE-LAMS 行首次意图。第一插管组的技术成功率和临床成功率分别为 83.5%和 70.2%，第一 LAMS 组分别为 100%和 89.3%（p=0.02 和 p=0.05）。第一插管组在整个患者治疗过程中的总体并发症发生率为 93.7%，第一 LAMS 组为 92.0%（p=0.04）。第一插管组的总体内镜并发症发生率为 30.5%，第一 LAMS 组为 17.9%（p=0.25）。第一插管组 PD 后的总体并发症发生率高于第一 LAMS 组（92.2%比 75.0%，p=0.016）。两组患者的总生存率和无进展生存率无差异。
在 DMBO 患者中，ECE-LAMS 行 PBD 比 ERCP 更容易操作且效率更高。与 PD 后并发症发生率较高相关，但不会影响肿瘤学结果。
