Department of Gastroenterology, The First Medical Center, Chinese PLA General Hospital, Fuxing Road, #28, Haidian District, Beijing, 100853, China.
Graduate School, Hainan Medical University, Haikou, 571199, China.
BMC Gastroenterol. 2023 Oct 5;23(1):344. doi: 10.1186/s12876-023-02976-0.
For high-risk elderly patients with chronic diseases, endoscopic stone removal for large common bile duct stones is associated with a high risk of adverse events and incomplete stone removal. The aim of this study was to investigate whether the treatment strategy of short-term biliary plastic stent placement followed by elective endoscopic stone removal is more effective and safer than immediate endoscopic stone removal.
The data of 262 high-risk elderly patients who received endoscopic retrograde cholangiopancreatography (ERCP) for large common bile duct (CBD) stones from 2017 to 2022 were retrospectively analyzed. The patients were divided into group A (immediate stone removal) and group B (stent drainage + elective stone removal). The baseline data of the 2 groups were matched 1:1 by propensity score matching. The stone clearance rate, ERCP procedure time, total hospital stay, and procedure-related adverse events were compared between the matched groups. In group B, stone size before and after stent placement, hospital stay, procedure time and adverse events of two ERCPs were compared.
A total of 57 pairs of patients were successfully matched between the 2 groups. The stone clearance rate in group B was higher than that in group A (89.5% vs. 75.3, P = 0.049). The total hospital stay in group B was longer than that in group A (11.86 ± 3.912 d vs. 19.14 ± 3.176 d, P<0.001). The total adverse event rate in group A was higher than that in group B (29.8% vs. 12.3%, P = 0.005). The incidence of cholangitis/cholecystitis after ERCP was significantly higher in group A than in group B (7.0% vs. 0.9% P = 0.029). There was no significant difference in the incidence of post-ERCP pancreatitis, bleeding, pneumonia, and cardio-cerebrovascular events between the 2 groups. There were no perforation cases in either group. After plastic biliary stent placement in group B, the stone size was significantly smaller than before stent placement (1.59 ± 0.544 cm vs. 1.95 ± 0.543 cm, P < 0.001), and there was no significant difference in the total adverse event incidence between the two ERCP procedures (18.8% vs. 10.9%, P = 0.214).
For high-risk elderly patients with large CBD stones, the treatment strategy involving temporary placement of plastic stent and elective endoscopic stone removal is safer and more effective than immediate stone removal.
对于患有慢性病的高危老年患者，内镜下取大的胆总管结石与不良事件和结石清除不完全的风险较高相关。本研究旨在探讨短期胆道塑料支架置入后择期内镜取石的治疗策略是否比立即内镜取石更有效和更安全。
回顾性分析 2017 年至 2022 年间 262 例接受内镜逆行胰胆管造影（ERCP）取大胆总管（CBD）结石的高危老年患者的数据。患者分为 A 组（立即取石）和 B 组（支架引流+择期内镜取石）。采用倾向评分匹配法对两组的基线数据进行 1:1 匹配。比较匹配组间的结石清除率、ERCP 操作时间、总住院时间和与操作相关的不良事件。在 B 组中，比较支架置入前后的结石大小、住院时间、操作时间和两次 ERCP 的不良事件。
两组共成功匹配 57 对患者。B 组的结石清除率高于 A 组（89.5% vs. 75.3%，P=0.049）。B 组的总住院时间长于 A 组（11.86±3.912 d vs. 19.14±3.176 d，P<0.001）。A 组的总不良事件发生率高于 B 组（29.8% vs. 12.3%，P=0.005）。A 组 ERCP 后胆管炎/胆囊炎的发生率明显高于 B 组（7.0% vs. 0.9%，P=0.029）。两组间 ERCP 后胰腺炎、出血、肺炎和心脑血管事件的发生率无显著差异。两组均无穿孔病例。B 组放置塑料胆道支架后，结石大小明显小于支架放置前（1.59±0.544 cm vs. 1.95±0.543 cm，P<0.001），两次 ERCP 总不良事件发生率无显著差异（18.8% vs. 10.9%，P=0.214）。
对于大 CBD 结石的高危老年患者，临时放置塑料支架和择期内镜取石的治疗策略比立即取石更安全、更有效。
