Department of Gastroenterology, The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing 100853, China.
Digestive Endoscopy Center, The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing 100853, China.
Chin Med J (Engl). 2024 Sep 5;137(17):2111-2118. doi: 10.1097/CM9.0000000000002893. Epub 2024 May 27.
Endoscopic papillectomy (EP) is recommended as the first-line therapy for ampullary tumors, despite a relatively high incidence of complications. Pancreatic and/or biliary stents are placed at the endoscopist's discretion to prevent post-EP complications. The present study aimed to evaluate the efficacy of different stents.
A total of 117 patients who underwent EP and met the criteria between June 2006 and October 2022 were enrolled in the study. These patients were divided into a pancreatic stent group (PS group, n = 47), a biliary stent group (BS group, n = 38), and a two-stent group (PBS [PS and BS] group, n = 32). Relevant clinical data were collected and compared among the three groups. Multivariate logistic analyses were performed to explore risk factors for post-EP complications.
The incidence of all complications was 37.6% (44/117). Pancreatitis and hemorrhage were the two most common complications with incidence rates of 14.5% (17/117) and 17.9% (21/117). The incidence rates of post-EP pancreatitis were 10.6% (5/47), 23.7% (9/38), and 9.4% (3/32) in the PS group, BS group, and PBS group, respectively, with no significant differences. There were also no significant differences in other complications among the three groups. Age (odds ratio [OR]: 0.95; 95% confidence interval [CI]: 0.91-0.99; P = 0.022) was independently associated with post-EP pancreatitis while tumor size (OR: 1.66; 95% CI: 1.06-2.60; P = 0.028) was independently associated with post-EP hemorrhage.
While pancreatic stenting is the first choice to prevent post-EP pancreatitis, biliary stenting could also be considered as a substitute for patients with difficulties in pancreatic cannulation. Two-stent (biliary and pancreatic stent) placement is unnecessary unless it is required due to other concerns.
尽管内镜下乳头括约肌切开术（EP）的并发症发生率相对较高，但仍是治疗壶腹肿瘤的首选方法。内镜医生会酌情放置胰管和/或胆管支架，以预防 EP 术后并发症。本研究旨在评估不同支架的疗效。
本研究纳入了 2006 年 6 月至 2022 年 10 月期间接受 EP 治疗且符合标准的 117 例患者。这些患者被分为胰管支架组（PS 组，n = 47）、胆管支架组（BS 组，n = 38）和双支架组（PS 和 BS 组，n = 32）。收集并比较了三组的相关临床资料。采用多变量逻辑分析探讨 EP 术后并发症的危险因素。
所有并发症的发生率为 37.6%（44/117）。胰腺炎和出血是最常见的两种并发症，发生率分别为 14.5%（17/117）和 17.9%（21/117）。PS 组、BS 组和 PBS 组 EP 术后胰腺炎的发生率分别为 10.6%（5/47）、23.7%（9/38）和 9.4%（3/32），三组间差异无统计学意义。三组间其他并发症发生率也无统计学差异。年龄（比值比 [OR]：0.95；95%置信区间 [CI]：0.91-0.99；P = 0.022）是 EP 术后胰腺炎的独立危险因素，而肿瘤大小（OR：1.66；95% CI：1.06-2.60；P = 0.028）是 EP 术后出血的独立危险因素。
胰管支架置入是预防 EP 术后胰腺炎的首选方法，但对于胰管插管困难的患者，胆管支架也可作为替代方法。除非因其他原因需要，否则不需要放置双支架（胰管和胆管支架）。
