Lopimpisuth Chawin, Vedantam Shyam, Danpanichkul Pojsakorn, Mahfouz Mahmoud, Orr Jordan, Javed Abid, Kumar Shria, Barkin Jodie A, Amin Sunil, Bhalla Sean
Department of Medicine, University of Miami/Jackson Health System, Miami, Florida, USA.
Division of Digestive Health and Liver Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA.
Gastrointest Endosc. 2025 Jul 1. doi: 10.1016/j.gie.2025.06.044.
Incidence of postprocedural cholecystitis after ERCP using a covered self-expandable metal stent (CSEMS) for distal malignant biliary obstruction (MBO) has been gradually reported. Without sufficient data, the recommendation for stent placement favors CSEMSs over uncovered self-expandable metal stents (USEMSs), with the tip placed below the cystic duct orifice. This study assessed the safety of CSEMSs versus USEMSs in the management of distal MBO.
All studies published up to December 2024 comparing adverse events after CSEMS and USEMS placement for biliary drainage were identified using PubMed, Embase, SCOPUS, and the Cochrane Library. Outcomes of interest were postprocedural cholecystitis, pancreatitis, stent migration, and tumor ingrowth. Pooled relative risks (RRs) with 95% CIs were calculated using a random-effect model. Subgroup analyses were performed based on study design and the presence of a gallbladder in situ.
Twenty-one studies (5753 patients) met inclusion criteria. The CSEMS group showed higher post-ERCP acute cholecystitis rates (RR, 1.71; 95% CI, 1.12-2.62), lower tumor in growth rates (RR, 0.13; 95% CI, 0.06-0.25), and higher rates of stent migration (RR, 7.53; 95% CI, 4.60-12.32). The difference was also demonstrated in subgroup analysis based on the presence of a gallbladder in situ.
Our study demonstrated higher rates of postprocedural cholecystitis following ERCP with CSEMS placement compared with USEMS placement. These findings highlight the importance of careful stent selection, particularly in patients with gallbladder in situ, to optimize patient care, reduce adverse events, and prevent delays in oncologic management.
使用覆膜自膨式金属支架（CSEMS）治疗远端恶性胆管梗阻（MBO）后发生术后胆囊炎的发生率已逐渐有报道。由于缺乏足够的数据，关于支架置入的建议倾向于使用CSEMS而非未覆膜自膨式金属支架（USEMS），且支架尖端应置于胆囊管开口下方。本研究评估了CSEMS与USEMS在治疗远端MBO中的安全性。
使用PubMed、Embase、SCOPUS和Cochrane图书馆检索截至2024年12月发表的所有比较CSEMS和USEMS置入胆道引流术后不良事件的研究。感兴趣的结局包括术后胆囊炎、胰腺炎、支架移位和肿瘤向内生长。使用随机效应模型计算合并相对风险（RR）及95%置信区间（CI）。根据研究设计和原位胆囊的存在情况进行亚组分析。
21项研究（5753例患者）符合纳入标准。CSEMS组显示ERCP术后急性胆囊炎发生率较高（RR，1.71；95%CI，1.12 - 2.62），肿瘤向内生长发生率较低（RR，0.13；95%CI，0.06 - 0.25），支架移位发生率较高（RR，7.53；95%CI，4.60 - 12.32）。基于原位胆囊存在情况的亚组分析也显示了这种差异。
我们的研究表明，与置入USEMS相比，置入CSEMS的ERCP术后胆囊炎发生率更高。这些发现凸显了谨慎选择支架的重要性，尤其是对于原位胆囊患者，以优化患者护理、减少不良事件并防止肿瘤治疗延迟。
