Bergman J J, Rauws E A, Tijssen J G, Tytgat G N, Huibregtse K
Department of Gastroenterology, University of Amsterdam, The Netherlands.
Gastrointest Endosc. 1995 Sep;42(3):195-201. doi: 10.1016/s0016-5107(95)70091-9.
Endoscopic sphincterotomy and stone extraction can clear the bile ducts in 85% to 90% of patients. In case endoscopic stone extraction fails, insertion of a biliary endoprosthesis is an alternative.
Biliary endoprostheses were inserted in 117 patients (73 women and 44 men, median age 80 years). Follow-up was achieved by contacting referring physicians and general practitioners.
Biliary drainage was established in all patients. Early complications occurred in 10 patients (9%) with a fatal outcome in 1. In 59 patients the endoprosthesis was a temporary measure before elective surgery or repeat endoscopy. Further treatment in these 59 patients caused only mild complications and there were no deaths. Endoprostheses were inserted as permanent therapy in 58 patients. Median follow-up in these 58 patients was 36 months (range, 1 to 117 months). A total of 34 complications occurred in 23 patients (40%), cholangitis being the most frequent. During follow-up, 44 patients died, 9 as a result of a biliary-related cause.
These data favor temporary use of biliary endoprostheses in patients with endoscopically irretrievable bile duct stones. However, as a permanent therapy, late complications occur in many patients and the risk increases proportionally in time. Therefore, permanent biliary stenting should preferably be restricted to patients unfit for elective treatment at a later stage and with a short life expectancy.
内镜括约肌切开取石术可使85%至90%的患者胆管通畅。若内镜取石失败，可选择置入胆道内支架。
对117例患者（73例女性，44例男性，中位年龄80岁）置入胆道内支架。通过联系转诊医生和全科医生进行随访。
所有患者均成功建立胆道引流。10例患者（9%）出现早期并发症，其中1例死亡。59例患者的内支架是择期手术或重复内镜检查前的临时措施。这59例患者的进一步治疗仅引起轻微并发症，无死亡病例。58例患者将内支架作为永久性治疗手段。这58例患者的中位随访时间为36个月（范围1至117个月）。23例患者（40%）共发生34例并发症，胆管炎最为常见。随访期间，44例患者死亡，其中9例死于与胆道相关的原因。
这些数据支持对内镜无法取出胆管结石的患者临时使用胆道内支架。然而，作为永久性治疗手段，许多患者会出现晚期并发症，且风险随时间成比例增加。因此，永久性胆道支架置入术最好仅限于那些不适合后期择期治疗且预期寿命较短的患者。
