LONG-TERM FOLLOW-UP OF PATIENTS UNDERGOING CHOLANGIOPANCREATOSCOPY-GUIDED LASER DISSECTION AND ABLATION FOR REFRACTORY PANCREATIC AND BILIARY STRICTURES.

IF 7.5 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy Pub Date : 2025-09-09 DOI:10.1016/j.gie.2025.08.059

Thomas Enke, Nicole Rueb, Fernanda Pessorrusso, Samuel Han, Raj J Shah

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引用次数: 0

Abstract

Background and aims: A subgroup of patients with benign biliary (BD) and pancreatic duct (PD) strictures fail to resolve with endoscopic retrograde cholangiopancreatography (ERCP)-guided stenting. Novel endoscopic approaches are needed. Our study aims to evaluate the efficacy and safety of cholangiopancreatoscopy-guided laser dissection or ablation (CPL) for the treatment of refractory pancreaticobiliary strictures.

Methods: Single-center retrospective review of all CPL cases performed for refractory BD or PD strictures. Primary outcome was stricture resolution.

Secondary outcomes: technical success, adverse events, and stent-free survival assessed using Kaplan-Meier analysis.

Results: Thirty patients underwent CPL from 5/2016 - 8/2023 and had a median 3 (interquartile range [IQR] 1-5) prior ERCPs to treat the stricture(s) of interest. Fifty-three CPL's were performed (median 1 per patient; IQR 1-2) for 49 strictures: 41 PD (83.7%; 17 body,15 head, 6 neck, and 3 tail) and 8 BD (16.3%; 5 common hepatic duct, 2 common bile duct, and 1 hilum). Complete and partial resolution occurred in 30 (61.2%) and 17 (34.7%) of strictures, respectively. Technical success was 100%. Stent-free trial was attempted in 25 (83.3%) patients after a median of 6 months (IQR 3-8) and median of 4 (IQR 2-4) ERCPs including index CPL and ERCP with stent removal. In 22 patients with follow-up data, reintervention with stenting occurred in 45.5% (n=10) with a median survival time of 32 months (95% confidence interval: 12-42). No severe adverse events occurred.

Conclusions: CPL has high technical success and an acceptable safety profile for the treatment of benign refractory BD and PD strictures.

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胆管镜引导下激光切除及消融治疗难治性胰腺及胆道狭窄患者的长期随访。

背景和目的：一组良性胆道（BD）和胰管（PD）狭窄的患者不能通过内镜逆行胆管造影（ERCP）引导的支架置入来解决。需要新的内窥镜入路。本研究旨在评价胆管镜引导下激光剥离或消融（CPL）治疗难治性胰胆管狭窄的疗效和安全性。方法：对所有难治性BD或PD狭窄行CPL的病例进行单中心回顾性分析。主要结局是结构解决。次要结局：采用Kaplan-Meier分析评估技术成功、不良事件和无支架生存期。结果：30例患者于2016年5月至2023年8月期间接受了CPL，既往ercp治疗感兴趣的狭窄的中位数为3（四分位间距[IQR] 1-5）。49例狭窄行53例CPL（中位1例/例；IQR 1-2）： PD 41例（83.7%；体17例，头15例，颈6例，尾3例），BD 8例（16.3%；肝总管5例，胆总管2例，门1例）。30例（61.2%）狭窄完全消退，17例（34.7%）狭窄部分消退。技术上的成功率是100%。25例（83.3%）患者在中位6个月（IQR 3-8）和中位4例（IQR 2-4） ERCP后进行无支架试验，包括指数CPL和ERCP并支架移除。在22例随访数据中，45.5% （n=10）的患者进行了支架再干预，中位生存时间为32个月（95%可信区间：12-42）。未发生严重不良事件。结论：CPL在治疗良性难治性BD和PD狭窄方面具有很高的技术成功率和可接受的安全性。

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

Gastrointestinal endoscopy 医学-胃肠肝病学

CiteScore

10.30

自引率

7.80%

发文量

1441

审稿时长

38 days

期刊介绍： Gastrointestinal Endoscopy is a journal publishing original, peer-reviewed articles on endoscopic procedures for studying, diagnosing, and treating digestive diseases. It covers outcomes research, prospective studies, and controlled trials of new endoscopic instruments and treatment methods. The online features include full-text articles, video and audio clips, and MEDLINE links. The journal serves as an international forum for the latest developments in the specialty, offering challenging reports from authorities worldwide. It also publishes abstracts of significant articles from other clinical publications, accompanied by expert commentaries.