多孔自膨式金属支架与全覆盖自膨式金属支架治疗不可切除胰腺癌恶性远端胆道梗阻的疗效对比

IF 1.4 Q4 GASTROENTEROLOGY & HEPATOLOGY DEN open Pub Date : 2024-09-24 DOI:10.1002/deo2.70014

Tsuyoshi Takeda, Takashi Sasaki, Takeshi Okamoto, Takafumi Mie, Yoichiro Sato, Yuri Maegawa, Tatsuki Hirai, Yukari Suzuki, Takaaki Furukawa, Masato Ozaka, Naoki Sasahira

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引用次数: 0

摘要

目的多孔自扩张金属支架（MHSEMS）是一种新型 SEMS，覆盖膜上有多个小侧孔，可防止支架移位，同时最大限度地减少肿瘤生长。本研究旨在评估 MHSEMS 与传统覆盖型 SEMS（c-CMS）相比的临床疗效。方法对因恶性远端胆道梗阻而接受初次 SEMS 置入术（MHSEMS 或 c-CMS）的不可切除胰腺癌患者进行分析。比较两组患者的技术成功率、临床成功率、复发性胆道梗阻（RBO）原因、非 RBO 不良事件、RBO 发生时间（TRBO）和内镜再介入情况。结果共纳入 65 例患者（MHSEMS：27 例，c-CMS：38 例）。两组的技术成功率、临床成功率和非RBO不良事件发生率相似。虽然 MHSEMS 组支架移位的发生率较低（0% 对 17.6%，p = 0.032），但两组的总体 RBO 发生率相似（53.8% 对 55.9%，p > 0.99）。MHSEMS组14天内发生RBO的最常见原因是非闭塞性胆管炎。MHSEMS组的中位TRBO明显缩短（101天 vs. 227天，p = 0.030），在多变量分析中，MHSEMS是TRBO缩短的独立预测因素（危险比为2.27；95%置信区间为1.06-4.86；p = 0.034）。内镜介入治疗后的结果在组间无明显差异。两组患者均能成功取出支架。结论与 c-CMS 相比，MHSEMS 的 TRBO 明显更短。目前的 MHSEMS 可能需要进一步修改。

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Outcomes of multi-hole self-expandable metal stents versus fully covered self-expandable metal stents for malignant distal biliary obstruction in unresectable pancreatic cancer

Objectives

The multi-hole self-expandable metal stent (MHSEMS) is a novel SEMS with multiple small side holes on the covering membrane to prevent stent migration while minimizing tumor ingrowth. This study aimed to evaluate the clinical outcomes of MHSEMS in comparison with conventional covered SEMS (c-CMS).

Methods

Consecutive patients with unresectable pancreatic cancer who underwent initial SEMS placement (MHSEMS or c-CMS) for malignant distal biliary obstruction were analyzed. Technical success, clinical success, causes of recurrent biliary obstruction (RBO), non-RBO adverse events, time to RBO (TRBO), and endoscopic reintervention were compared between groups.

Results

A total of 65 patients were included (MHSEMS: 27, c-CMS: 38). The technical success, clinical success, and non-RBO adverse event rates were similar between groups. Although stent migration was less frequently observed in the MHSEMS group (0% vs. 17.6%, p = 0.032), overall RBO rates were similar between groups (53.8% vs. 55.9%, p > 0.99). The most common cause of RBO within 14 days in the MHSEMS group was non-occlusion cholangitis. Median TRBO was significantly shorter in the MHSEMS group (101 vs. 227 days, p = 0.030) and MHSEMS was an independent predictor for shorter TRBO in multivariate analysis (hazard ratio, 2.27; 95% confidence interval, 1.06–4.86; p = 0.034). Outcomes after endoscopic interventio were not significantly different between groups. Stent removal was successful in all attempted cases in both groups.