Jin Hengwei, Fu Chang, Sun Xu, Fan Changqing, Chen Junhong, Zhou Hao, Liu Kai, Xu Hongji
Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, Jilin, China.
Clinical Medical College, Changchun University of Traditional Chinese Medicine, Changchun, Jilin, China.
Front Oncol. 2024 Nov 14;14:1440131. doi: 10.3389/fonc.2024.1440131. eCollection 2024.
Endoscopic retrograde cholangiopancreatography(ERCP) with endoscopic metallic biliary endoprosthesis(EMBE) serves as a crucial palliative treatment for advanced malignant biliary obstruction(MBO). While endoscopic nasobiliary drainage(ENBD) effectively reduces post-ERCP cholangitis (PEC) incidence, its impact on PEC in MBO patients is unclear. This study evaluates ENBD's effects on PEC in patients undergoing EMBE and identifies risk factors.
This retrospective cohort study at the First Hospital of Jilin University involved MBO patients who underwent EMBE from September 2011 to September 2022. Propensity score matching (PSM) was applied to minimize selection bias. Primary and secondary outcomes included the incidence and recovery rate/time of PEC, biliary drainage success, and hospitalization duration. Univariate, multivariate, and Lasso regression analyses identified independent risk factors.
In this study of 1,008 patients, 730 were analyzed after PSM(365 each in the EMBE+ENBD and EMBE groups). No significant differences were observed in PEC incidence(10.7% vs 11.2%, p=0.9057) or recovery rates(48.7% vs 31.7%, p=0.1855). However, PEC recovery time was shorter in the EMBE+ENBD group(4.0 days [3.0, 6.0] vs 5.0 days [4.0, 7.5], p=0.0240), as was hospitalization duration(6.0 days [4.0, 8.0] vs 7.0 days [5.0, 10.0], p=0.0146), and a higher success rate of biliary drainage(54.0% vs 43.3%, p=0.0049). Tumor location(HR 1.10, 95% CI 1.00-1.20) and preoperative total bilirubin(HR 2.13, 95% CI 1.66-2.73) were identified as independent risk factors.
In this large-scale PSM study, ENBD did not reduce PEC incidence but expedited recovery and shortened hospital stays. Patients with hilar MBO of Bismuth III-IV or high preoperative bilirubin were more prone to PEC.
内镜逆行胰胆管造影术（ERCP）联合内镜金属胆道内支架置入术（EMBE）是晚期恶性胆管梗阻（MBO）的重要姑息治疗方法。虽然内镜鼻胆管引流术（ENBD）可有效降低ERCP术后胆管炎（PEC）的发生率，但其对MBO患者PEC的影响尚不清楚。本研究评估ENBD对接受EMBE患者PEC的影响，并确定危险因素。
这项在吉林大学第一医院进行的回顾性队列研究纳入了2011年9月至2022年9月期间接受EMBE的MBO患者。采用倾向评分匹配（PSM）以尽量减少选择偏倚。主要和次要结局包括PEC的发生率和恢复率/时间、胆道引流成功率及住院时间。单因素、多因素和Lasso回归分析确定独立危险因素。
在本研究的1008例患者中，PSM后分析了730例（EMBE+ENBD组和EMBE组各365例）。PEC发生率（10.7%对1⏥2%，p=0.9057）或恢复率（48.7%对31.7%，p=0.1855）无显著差异。然而，EMBE+ENBD组的PEC恢复时间较短（4.0天[3.0，6.0]对5.0天[4.0，7.5]，p=0.0240），住院时间也较短（6.0天[4.0，8.0]对7.0天[⏥0，10.0]，p=0.0146），且胆道引流成功率更高（54.0%对43.3%，p=0.0049）。肿瘤位置（HR 1.10，95%CI 1.00 - 1.20）和术前总胆红素（HR 2.13，95%CI 1.66 - 2.73）被确定为独立危险因素。
在这项大规模PSM研究中，ENBD并未降低PEC的发生率，但加快了恢复并缩短了住院时间。Bismuth III - IV型肝门部MBO或术前胆红素水平高的患者更容易发生PEC。
