Thomas Enke, Nicole Rueb, Fernanda Pessorrusso, Samuel Han, Raj J Shah
{"title":"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。","authors":"Thomas Enke, Nicole Rueb, Fernanda Pessorrusso, Samuel Han, Raj J Shah","doi":"10.1016/j.gie.2025.08.059","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and aims: </strong>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.</p><p><strong>Methods: </strong>Single-center retrospective review of all CPL cases performed for refractory BD or PD strictures. Primary outcome was stricture resolution.</p><p><strong>Secondary outcomes: </strong>technical success, adverse events, and stent-free survival assessed using Kaplan-Meier analysis.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>CPL has high technical success and an acceptable safety profile for the treatment of benign refractory BD and PD strictures.</p>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":" ","pages":""},"PeriodicalIF":7.5000,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"LONG-TERM FOLLOW-UP OF PATIENTS UNDERGOING CHOLANGIOPANCREATOSCOPY-GUIDED LASER DISSECTION AND ABLATION FOR REFRACTORY PANCREATIC AND BILIARY STRICTURES.\",\"authors\":\"Thomas Enke, Nicole Rueb, Fernanda Pessorrusso, Samuel Han, Raj J Shah\",\"doi\":\"10.1016/j.gie.2025.08.059\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and aims: </strong>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.</p><p><strong>Methods: </strong>Single-center retrospective review of all CPL cases performed for refractory BD or PD strictures. Primary outcome was stricture resolution.</p><p><strong>Secondary outcomes: </strong>technical success, adverse events, and stent-free survival assessed using Kaplan-Meier analysis.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>CPL has high technical success and an acceptable safety profile for the treatment of benign refractory BD and PD strictures.</p>\",\"PeriodicalId\":12542,\"journal\":{\"name\":\"Gastrointestinal endoscopy\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":7.5000,\"publicationDate\":\"2025-09-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Gastrointestinal endoscopy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.gie.2025.08.059\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Gastrointestinal endoscopy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.gie.2025.08.059","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
LONG-TERM FOLLOW-UP OF PATIENTS UNDERGOING CHOLANGIOPANCREATOSCOPY-GUIDED LASER DISSECTION AND ABLATION FOR REFRACTORY PANCREATIC AND BILIARY STRICTURES.
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.
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.
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