Takahashi Koji, Ohyama Hiroshi, Kan Motoyasu, Ouchi Mayu, Nagashima Hiroki, Okitsu Kohichiroh, Ohno Izumi, Kato Naoya
Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba; Department of Medical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan.
Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan.
J Gastrointestin Liver Dis. 2025 Jun 28;34(2):214-219. doi: 10.15403/jgld-5933.
This study aimed to evaluate the efficacy and safety of transpapillary simultaneous side-by-side (SBS) stenting using uncovered self-expandable metal stents (UCSEMSs) at the initial endoscopic retrograde cholangiopancreatography (ERCP) for unresectable malignant hilar biliary obstruction (UMHBO).
A total of 67 patients with UMHBO who underwent simultaneous SBS stenting at our institution were retrospectively divided into two groups: the SBS stenting at the initial ERCP group (n=13) and the SBS stenting at the subsequent ERCP group (n=54). Clinical outcomes were compared between the groups.
There were no significant differences between the SBS stenting at the initial ERCP group and the SBS stenting at the subsequent ERCP group in procedural time (median: 50 vs. 40 minutes, p=0.31), functional success rate (69.2% vs. 83.3%, p=0.25), adverse event rate (30.8% vs. 14.8%, p=0.18), recurrent biliary obstruction (RBO) rate (23.1% vs. 38.9%, p=0.29), technical success rate of re-intervention (100% vs. 90.5%, p=0.58), cumulative time to RBO (not reached vs. 252 days, p=0.80), or median overall survival (73 vs. 212 days, p=0.12).
Simultaneous SBS stenting using UCSEMSs at the initial ERCP is a safe and effective strategy for managing UMHBO, with outcomes comparable to those of SBS stenting performed at the subsequent ERCP.
本研究旨在评估在初次内镜逆行胰胆管造影术（ERCP）时使用无覆膜自膨式金属支架（UCSEMSs）经乳头同步并排（SBS）支架置入术治疗不可切除性恶性肝门部胆管梗阻（UMHBO）的疗效和安全性。
对在我院接受同步SBS支架置入术的67例UMHBO患者进行回顾性分组，分为初次ERCP时进行SBS支架置入术组（n = 13）和后续ERCP时进行SBS支架置入术组（n = 54）。比较两组的临床结局。
初次ERCP时进行SBS支架置入术组与后续ERCP时进行SBS支架置入术组在操作时间（中位数：50对40分钟，p = 0.31）、功能成功率（69.2%对83.3%，p = 0.25）、不良事件发生率（30.8%对14.8%，p = 0.18）、复发性胆管梗阻（RBO）发生率（23.1%对38.9%，p = 0.29）、再次干预的技术成功率（100%对90.5%，p = 0.58）、至RBO的累积时间（未达到对252天，p = 0.80）或中位总生存期（73对212天，p = 0.12）方面均无显著差异。
在初次ERCP时使用UCSEMSs进行同步SBS支架置入术是治疗UMHBO的一种安全有效的策略，其结果与在后续ERCP时进行SBS支架置入术相当。
