Clinical outcomes of biliary and duodenal self-expandable metal stent placements for palliative treatment in patients with periampullary cancer

Gastrointestinal Intervention Pub Date : 2017-10-31 DOI:10.18528/GII170013

Hong-Joo Kim

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引用次数: 1

Abstract

Background: Endoscopic self-expandable metal stent (SEMS) insertions for palliation of malignant biliary and duodenal obstructions have been re- vealed to be an effective treatment. We present our clinical experience with the use of SEMS for malignant biliary and duodenal obstructions caused by periampullary cancer. Methods: We performed a retrospective review of all patients who underwent endoscopic biliary and duodenal SEMS insertion for palliation of ma lignant biliary and duodenal obstruction caused by periampullary cancer between July 2007 and October 2016. The patients received simultaneous or sequential endoscopic biliary stenting and duodenal stenting with COMVI TM stents (partially covered; Taewoong, Seoul, Korea). Results: The final diagnoses of our enrolled patients were 15 pancreas head cancer, and 3 distal common bile duct (CBD) cancer. The main stricture site in the duodenum was bulb (n = 4, 22.2%), 2nd portion (n = 9, 50.0%), and 3rd portion (n = 5, 27.8%). The technical success rates of CBD and du odenal stenting were 100% (18/18), and 100% (18/18), respectively. The clinical success rates of CBD and duodenal stenting were 100% (18/18), and 88.9% (16/18), respectively. Median actuarial stent patency for biliary and duodenal SEMS were 6.5 months (range, 1–12 months) and 4.5 months (range, 1–14 months), respectively. Three patients (16.7%) had recurrent biliary obstruction and all of them underwent percutaneous trans-hepatic biliary drainage (PTBD) with biliary SEMS reinsertion. Three other patients (16.7%, totally different from patients with CBD restenosis) had recurrent duodenal obstruction and all of them underwent upper gastrointestinal endoscopy with duodenal SEMS reinsertion. Conclusion: Endoscopic SEMS insertions for simultaneous palliation of malignant biliary and duodenal obstruction in patients with periampullary cancer may provide a safe, and less invasive alternative to surgical palliation with a successful clinical outcome.

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癌症患者胆道和十二指肠可自膨胀金属支架姑息治疗的临床结果

背景:内镜下自膨胀金属支架(SEMS)插入缓解恶性胆道和十二指肠梗阻已被发现是一种有效的治疗方法。我们介绍了我们的临床经验，使用SEMS对壶腹周围癌引起的恶性胆道和十二指肠梗阻。方法:回顾性分析2007年7月至2016年10月期间所有接受内镜胆道和十二指肠SEMS插入治疗壶腹周围癌引起的恶性胆道和十二指肠梗阻的患者。患者同时或顺序接受内镜下胆道支架置入和十二指肠支架置入COMVI TM(部分覆盖;韩国首尔太雄)。结果:本组患者最终诊断为胰头癌15例，远端胆总管癌3例。十二指肠主要狭窄部位为十二指肠球部(n = 4, 22.2%)、十二指肠第二部(n = 9, 50.0%)、十二指肠第三部(n = 5, 27.8%)。CBD和十二指肠支架术的技术成功率分别为100%(18/18)和100%(18/18)。CBD和十二指肠支架术的临床成功率分别为100%(18/18)和88.9%(16/18)。胆道和十二指肠SEMS的中位精算支架通畅度分别为6.5个月(范围1-12个月)和4.5个月(范围1-14个月)。3例(16.7%)复发性胆道梗阻，均行经皮经肝胆道引流术(PTBD)合并胆道SEMS复位。另有3例(16.7%，与CBD再狭窄患者完全不同)复发性十二指肠梗阻，均行上消化道内镜下十二指肠SEMS再置入。结论:内镜下SEMS插入治疗壶腹周围癌患者的恶性胆道和十二指肠梗阻，可能是一种安全、微创的手术缓解方法，具有成功的临床效果。

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来源期刊

Gastrointestinal Intervention

自引率

0.00%

发文量

审稿时长

24 weeks

期刊介绍： IJGII (pISSN 2636-0004, eISSN 2636-0012) was published four times a year on the last day of January, April, July, and October, which has effected from January 1 in 2019. This Journal was first published biannually on June and December, beginning in December 2012 under the title ‘Gastrointestinal Intervention’ (former pISSN 2213-1795, eISSN 2213-1809) and was changed to be published three times a year from 2016. Commencing with the January 2019 issue, the Journal was renamed ‘International Journal of Gastrointestinal Intervention’. As the official journal of the Society of Gastrointestinal Intervention (SGI), International Journal of Gastrointestinal Intervention (IJGII) delivers original, peer-reviewed articles for gastroenterologists, interventional radiologists, surgeons, gastrointestinal oncologists, nurses and technicians who need current and reliable information on the interventional treatment of gastrointestinal and hepatopancreaticobiliary diseases. Regular features also include ‘state-of-the-art’ review articles by leading authorities throughout the world. IJGII will become an international forum for the description and discussion of the various aspects of interventional radiology, endoscopy and minimally invasive surgery.