Sakai Arata, Masuda Atsuhiro, Takenaka Mamoru, Shiomi Hideyuki, Omoto Shunsuke, Yoshida Akihiro, Nakano Ryota, Kawase Yuta, Kohashi Shinya, Kodama Yuzo
Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan.
J Hepatobiliary Pancreat Sci. 2025 Jul;32(7):554-561. doi: 10.1002/jhbp.12157. Epub 2025 May 12.
The use of 10-mm fully covered self-expandable metal stents for preoperative bile duct drainage in patients with pancreatic cancer is increasing. However, these can cause complications (cholecystitis and pancreatitis) that may affect surgical outcomes. Smaller-diameter self-expandable metal stents may reduce these risks; however, the optimal stent size is unclear.
Patients with pancreatic cancer who underwent neoadjuvant chemotherapy and placement of either 6 or 10-mm fully covered self-expandable metal stents for malignant distal biliary obstruction were included. The primary outcome was the 90-day incidence of recurrent biliary obstruction. Secondary outcomes were non-recurrent biliary obstruction and adverse events.
Fifty-three patients were enrolled (27 and 26 patients received 6-mm and 10-mm self-expandable metal stents, respectively). The 90-day incidence of recurrent biliary obstruction of the 6-mm group was significantly higher than that of the 10-mm group (30.8% vs. 3.8%; p = 0.02). Stent migration occurred more frequently in the 6-mm group (26.9% vs. 0%; p = 0.01). Although non-recurrent biliary obstruction adverse events were less common in the 6-mm group, the difference was not statistically significant (11.1% vs. 23.0%; p = 0.29).
The 10-mm self-expandable metal stents were more suitable for the preoperative management of pancreatic cancer.
10毫米全覆膜自膨式金属支架在胰腺癌患者术前胆管引流中的应用日益增加。然而，这些支架可能会引发胆囊炎和胰腺炎等并发症，进而影响手术效果。直径较小的自膨式金属支架或许能降低这些风险；然而，最佳支架尺寸尚不清楚。
纳入接受新辅助化疗且因恶性远端胆管梗阻置入6毫米或10毫米全覆膜自膨式金属支架的胰腺癌患者。主要结局是90天复发性胆管梗阻的发生率。次要结局是非复发性胆管梗阻和不良事件。
共纳入53例患者（27例和26例患者分别接受了6毫米和10毫米自膨式金属支架）。6毫米组90天复发性胆管梗阻的发生率显著高于10毫米组（30.8%对3.8%；p = 0.02）。6毫米组支架移位更频繁（26.9%对0%；p = 0.01）。尽管6毫米组非复发性胆管梗阻不良事件较少见，但差异无统计学意义（11.1%对23.0%；p = 0.29）。
10毫米自膨式金属支架更适合胰腺癌的术前治疗。
