Risk factors for recurrent biliary obstruction following suprapapillary placement of a plastic stent as preoperative biliary drainage for perihilar biliary malignancy

IF 3.2 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Hepato‐Biliary‐Pancreatic Sciences Pub Date : 2024-07-24 DOI:10.1002/jhbp.12043

Kunio Kataoka, Takuya Ishikawa, Kentaro Yamao, Yasuyuki Mizutani, Tadashi Iida, Kota Uetsuki, Shunsuke Onoe, Takashi Mizuno, Tomoki Ebata, Hiroki Kawashima

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引用次数: 0

Abstract

Background/Purpose

The usefulness of endoscopic biliary stenting by deploying a plastic stent suprapapillary, called inside-stent (IS) placement, as preoperative biliary drainage (PBD) for perihilar biliary malignancy (PHBM) has been demonstrated. This study investigated risk factors for recurrent biliary obstruction (RBO) after IS placement.

Methods

Consecutive patients with potentially resectable PHBM treated with IS placement as PBD between 2017 and 2023 at Nagoya University Hospital were retrospectively reviewed.

Results

A total of 157 patients were included, with RBO occurring in 34 (22%) patients. The non-RBO rates were 83% at 30 days, 77% at 60 days, and 57% at 90 days. The most common cause of RBO was stent occlusion (n = 14), followed by segmental cholangitis (n = 12) and stent migration (n = 8). Stent migration and occlusion occurred more frequently within and after 1 week post-stenting, respectively. In multivariate analysis, biliary infection before IS was the sole risk factor for RBO, with a hazard ratio of 2.404 (95% confidence interval 1.163–4.972; p = .018). This risk was reduced by temporary endoscopic nasobiliary drainage prior to definitive IS placement.

Conclusions

Biliary infection before IS was identified as an independent risk factor for RBO in patients with PHBM with IS as PBD.

Clinical Trial Register

Clinical trial registration number: UMIN000025631.

Abstract Image

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乳头上置入塑料支架作为肝周胆道恶性肿瘤术前胆道引流后复发胆道梗阻的风险因素。

背景/目的：内镜胆道支架置入术（即内支架（IS）置入术）通过在乳头上部置入塑料支架作为术前胆道引流（PBD）治疗肝周胆道恶性肿瘤（PHBM）的有效性已得到证实。本研究调查了置入 IS 后复发胆道梗阻（RBO）的风险因素：方法：回顾性研究名古屋大学医院2017年至2023年间连续接受IS置入术作为PBD治疗的潜在可切除PHBM患者：结果：共纳入 157 例患者，其中 34 例（22%）患者出现 RBO。30天内无RBO的比例为83%，60天内为77%，90天内为57%。导致 RBO 的最常见原因是支架闭塞（14 例），其次是节段性胆管炎（12 例）和支架移位（8 例）。支架移位和闭塞分别多发生在支架植入后一周内和一周后。在多变量分析中，IS前胆道感染是RBO的唯一风险因素，其危险比为2.404（95%置信区间为1.163-4.972；P = .018）。在最终置入IS前进行临时内镜鼻胆管引流可降低这一风险：临床试验注册：临床试验注册号：UMIN000025631：UMIN000025631。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Hepato‐Biliary‐Pancreatic Sciences GASTROENTEROLOGY & HEPATOLOGY-SURGERY

自引率

10.00%

发文量

178

审稿时长

6-12 weeks

期刊介绍： The Journal of Hepato-Biliary-Pancreatic Sciences (JHBPS) is the leading peer-reviewed journal in the field of hepato-biliary-pancreatic sciences. JHBPS publishes articles dealing with clinical research as well as translational research on all aspects of this field. Coverage includes Original Article, Review Article, Images of Interest, Rapid Communication and an announcement section. Letters to the Editor and comments on the journal’s policies or content are also included. JHBPS welcomes submissions from surgeons, physicians, endoscopists, radiologists, oncologists, and pathologists.