Metal Stents for the Management of Massive Hemobilia in Patients with Hilum-Involving Cholangiocarcinoma Receiving Multi-Regimen Chemotherapy.

IF 3.4 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Gut and Liver Pub Date : 2024-11-07 DOI:10.5009/gnl240087
Seung Yeon Lee, Min Je Sung, Suk Pyo Shin, Hong Jae Chon, Beodeul Kang, Kwang Hyun Ko, Mamoru Takenaka, Chang-Il Kwon
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Abstract

Recent clinical outcomes of multi-regimen chemotherapy in patients with cholangiocarcinoma (CCC) have shown benefits in terms of overall survival. However, repeated endoscopic biliary drainage (EBD) and serious adverse events negatively affect prolongation of the survival period. The aim of this study was to investigate the prevalence of massive hemobilia and the outcomes of its management with fully covered self-expandable metal stents (FC-SEMSs) in patients with hilum-involving CCC receiving multi-regimen chemotherapy. The methods and effects of FC-SEMS placement were retrospectively investigated following the occurrence of massive hemobilia during EBD. A total of 356 patients with CCC received multi-regimen chemotherapy. Among them, 181 patients had hilar invasion, and seven patients (3.9%) developed massive hemobilia during repeated EBD using removable stents. In all cases, the tumor encased the right hepatic artery. In six patients (85.7%), hemostasis was immediately and completely achieved by inserting one or two FC-SEMSs proximal to the hilar invasion area. Therefore, if the tumor encases the right hepatic artery, massive hemobilia is likely to occur during multi-regimen chemotherapy. Thus, prompt placement of a FC-SEMS would be an effective treatment option for massive hemobilia in patients with hilum-involving CCC.

金属支架用于治疗接受多方案化疗的肝门部胆管癌患者的大量出血。
对胆管癌(CCC)患者进行多方案化疗的最新临床结果显示,患者的总生存期有所延长。然而,反复内镜胆道引流术(EBD)和严重不良事件对生存期的延长产生了负面影响。本研究旨在调查接受多方案化疗的肝门部受累 CCC 患者中大量血肿的发生率以及使用全覆盖自膨胀金属支架(FC-SEMS)治疗的效果。在 EBD 期间发生大出血后,我们对放置 FC-SEMS 的方法和效果进行了回顾性研究。共有356名CCC患者接受了多方案化疗。其中,181 例患者有肺门侵犯,7 例患者(3.9%)在使用可拆卸支架反复进行 EBD 期间出现大量出血。在所有病例中,肿瘤都包裹着右肝动脉。在六名患者(85.7%)中,通过在肝门侵犯区域近端插入一个或两个 FC-SEMS 即刻完全止血。因此,如果肿瘤包绕右肝动脉,在多方案化疗期间很可能会出现大量出血。因此,对于肝门受侵的 CCC 患者,及时置入 FC-SEMS 将是治疗大量出血的有效方法。
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来源期刊
Gut and Liver
Gut and Liver 医学-胃肠肝病学
CiteScore
7.50
自引率
8.80%
发文量
119
审稿时长
6-12 weeks
期刊介绍: Gut and Liver is an international journal of gastroenterology, focusing on the gastrointestinal tract, liver, biliary tree, pancreas, motility, and neurogastroenterology. Gut and Liver delivers up-to-date, authoritative papers on both clinical and research-based topics in gastroenterology. The Journal publishes original articles, case reports, brief communications, letters to the editor and invited review articles in the field of gastroenterology. The Journal is operated by internationally renowned editorial boards and designed to provide a global opportunity to promote academic developments in the field of gastroenterology and hepatology. Gut and Liver is jointly owned and operated by 8 affiliated societies in the field of gastroenterology, namely: the Korean Society of Gastroenterology, the Korean Society of Gastrointestinal Endoscopy, the Korean Society of Neurogastroenterology and Motility, the Korean College of Helicobacter and Upper Gastrointestinal Research, the Korean Association for the Study of Intestinal Diseases, the Korean Association for the Study of the Liver, the Korean Pancreatobiliary Association, and the Korean Society of Gastrointestinal Cancer.
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