Kulpatcharapong Santi, Piyachaturawat Panida, Mekaroonkamol Parit, Angsuwatcharakon Phonthep, Ridtitid Wiriyaporn, Kongkam Pradermchai, Rerknimitr Rungsun
Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Thai Red Cross Society, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Rama 4 Road, Patumwan, Bangkok, 10330, Thailand.
Department of Anatomy, Faculty of Medicine, Thai Red Cross Society, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Surg Endosc. 2024 Jan;38(1):212-221. doi: 10.1007/s00464-023-10541-9. Epub 2023 Nov 14.
Self-expandable metal stent (SEMS) insertion is the standard palliative treatment for unresectable malignant extrahepatic biliary obstruction (MBO). Drawbacks of conventional fully covered SEMS (FCSEMS) and uncovered SEMS (USEMS) include stent migration and tumor ingrowth, respectively. This study aimed to compare stent patency in MBO with the newly design multi-hole SEMS (MHSEMS), which has multiple small side holes in the stent membrane, with conventional FCSEMS and UCSEMS.
This retrospective study using a propensity score matching design and stent patency times of 40 patients with MHSEMS was compared to 40 and 34 patients with FCSEMS and UCSEMS during the same period, respectively. Secondary outcomes were procedure-related adverse events, clinical success rate, time to recurrent biliary obstruction (RBO), and etiology of RBO. RBO was compared using Kaplan-Meier analysis.
Baseline characteristics after matching were comparable among the 3 groups. RBO rates were 21%, 37%, and 55% for MHSEMS, FCSEMS, and UCSEMS, respectively (p = 0.014), at a mean time of 479, 353, and 306 days, respectively (MHSEMS vs UCSEMS, p = 0.002). Rate of tumor ingrowth was highest in the UCSEMS group (42.4% vs 13.2% in MHSEMS; p = 0.005 and vs 0% in FCSEMS; p < 0.001). Stent migration rate was highest in the FCSEMS group at 15.8% vs 2.6% in MHSEMS (p = 0.047) and 0% in UCSEMS (p = 0.005).
MHSEMS provided the longest stent patency time with lowest RBO rate compared to conventional SEMS by showing a lower stent migration rate than FCSEMS and a lower tumor ingrowth rate than UCSEMS.
自膨式金属支架（SEMS）置入术是不可切除的恶性肝外胆管梗阻（MBO）的标准姑息治疗方法。传统的全覆膜SEMS（FCSEMS）和裸支架SEMS（USEMS）的缺点分别是支架移位和肿瘤长入。本研究旨在比较MBO患者中新型多孔SEMS（MHSEMS，其支架膜上有多个小侧孔）与传统FCSEMS和UCSEMS的支架通畅情况。
本回顾性研究采用倾向评分匹配设计，将40例使用MHSEMS的患者的支架通畅时间分别与同期40例使用FCSEMS和34例使用UCSEMS的患者进行比较。次要结局指标为与手术相关的不良事件、临床成功率、复发性胆管梗阻（RBO）时间以及RBO的病因。使用Kaplan-Meier分析比较RBO情况。
匹配后的基线特征在3组之间具有可比性。MHSEMS、FCSEMS和UCSEMS的RBO发生率分别为21%、37%和55%（p = 0.014），平均时间分别为479天、353天和306天（MHSEMS与UCSEMS比较，p = 0.002）。UCSEMS组的肿瘤长入率最高（42.4%，MHSEMS为13.2%；p = 0.005，FCSEMS为0%；p < 0.001）。FCSEMS组的支架移位率最高，为15.8%，而MHSEMS为2.6%（p = 0.047），UCSEMS为0%（p = 0.005）。
与传统SEMS相比，MHSEMS的支架通畅时间最长，RBO发生率最低，其支架移位率低于FCSEMS，肿瘤长入率低于UCSEMS。
