覆膜与非覆膜自膨式金属支架治疗远端恶性胆道梗阻的比较。
Uncovered versus fully covered self-expandable metal stents for the management of distal malignant biliary obstruction.
机构信息
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
出版信息
Gastrointest Endosc. 2023 Oct;98(4):577-584.e4. doi: 10.1016/j.gie.2023.05.047. Epub 2023 May 16.
BACKGROUND AND AIM
Self-expandable metal stents (SEMSs) are widely used for palliation of distal malignant biliary obstruction (dMBO). However, previous studies comparing the outcomes between uncovered SEMSs (UCSEMSs) and fully covered SEMSs (FCSEMSs) report conflicting results. This large cohort study aimed to compare the clinical outcomes between UCSEMSs and FCSEMSs for dMBO.
METHODS
A retrospective cohort study was performed in patients with dMBO who underwent either UCSEMS or FCSEMS placement between May 2017 and May 2021. Primary outcomes were rates of clinical success, adverse events (AEs), and unplanned endoscopic reintervention. Secondary outcomes were types of AEs, intervention-free stent patency, and management and outcomes of stent occlusion.
RESULTS
The cohort included 454 patients (364 in the UCSEMS group and 90 in the FCSEMS group). Median follow-up duration was 9.6 months and was similar between the 2 groups. Use of UCSEMSs and FCSEMSs had comparable clinical success (P = .250). However, use of UCSEMSs had significantly higher rates of AEs (33.5% vs 21.1%; P = .023) and unplanned endoscopic reintervention (27.0% vs 11.1%; P = .002). UCSEMSs had a higher rate of stent occlusion (26.9% vs 8.9%; P < .001) and shorter median time to stent occlusion (4.4 months vs 10.7 months; P = .002). Stent reintervention-free survival was higher in the FCSEMS group. FCSEMSs had a significantly higher rate of stent migration (7.8% vs 1.1%; P < .001), but patients in the FCSEMS group had similar rates of cholecystitis (.3% vs 1.1%; P = .872) and post-ERCP pancreatitis (6.3% vs 6.6%; P = .90). When UCSEMSs did occlude, placement of a coaxial plastic stent had a higher rate of stent reocclusion compared with coaxial SEMS placement (46.7% vs 19.7%; P = .007).
CONCLUSION
FCSEMSs should be considered for the palliation of dMBO because of lower rates of AEs, longer patency rates, and lower rates of unplanned endoscopic intervention.
背景与目的
自膨式金属支架（SEMS）广泛用于缓解远端恶性胆道梗阻（dMBO）。然而，先前比较无覆盖 SEMS（UCSEMS）和完全覆盖 SEMS（FCSEMS）治疗结果的研究报告结果相互矛盾。本大规模队列研究旨在比较 dMBO 患者中 UCSEMS 和 FCSEMS 的临床结局。
方法
对 2017 年 5 月至 2021 年 5 月期间接受 UCSEMS 或 FCSEMS 治疗的 dMBO 患者进行回顾性队列研究。主要结局为临床成功率、不良事件（AE）和计划外内镜再介入的发生率。次要结局为 AE 类型、无干预支架通畅率以及支架闭塞的处理和结局。
结果
该队列纳入了 454 名患者（UCSEMS 组 364 名，FCSEMS 组 90 名）。中位随访时间为 9.6 个月，两组间相似。UCSEMS 和 FCSEMS 的临床成功率相当（P=0.250）。然而，UCSEMS 的 AE 发生率（33.5%比 21.1%；P=0.023）和计划外内镜再介入率（27.0%比 11.1%；P=0.002）更高。UCSEMS 的支架闭塞率更高（26.9%比 8.9%；P<0.001），中位支架闭塞时间更短（4.4 个月比 10.7 个月；P=0.002）。FCSEMS 组的支架再干预无复发生存率更高。FCSEMS 的支架迁移率明显更高（7.8%比 1.1%；P<0.001），但 FCSEMS 组胆囊炎的发生率相似（0.3%比 1.1%；P=0.872），内镜逆行胰胆管造影术后胰腺炎的发生率也相似（6.3%比 6.6%；P=0.90）。当 UCSEMS 发生闭塞时，与同轴 SEMS 放置相比，同轴塑料支架放置的支架再闭塞率更高（46.7%比 19.7%；P=0.007）。
结论
由于 AE 发生率较低、通畅率较高和计划外内镜干预率较低，FCSEMS 应考虑用于 dMBO 的姑息治疗。
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