置管金属支架加或不加同轴塑料支架用于胰液收集的安全性和有效性

IF 16.4 1区 化学 Q1 CHEMISTRY, MULTIDISCIPLINARY
James D. Haddad, Thomas Tielleman, Andrew Fuller, Anna Tavakkoli, Dutch Vanderveldt, Markus Goldschmiedt, Nisa Kubiliun, Tarek Sawas
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引用次数: 2

摘要

背景和目的胰腺积液(PFCs)是急性胰腺炎的常见并发症,可导致疼痛、进食困难和感染。内窥镜超声引导引流已成为护理标准,腔贴附金属支架(LAMS)取代双尾纤塑料支架(DPPS)成为首选设备。假设通过LAMS同轴放置DPPS可以降低与LAMS相关的不良事件的风险。我们进行了一项回顾性研究,以评估该策略的安全性和有效性。方法我们对2016年1月至2022年11月在两个美国学术三级护理中心接受LAMS和DPPS或LAMS内镜下囊体造口术的连续PFCs患者进行了回顾性研究。使用倾向性评分和调整后的逻辑回归模型进行分析。结果我们纳入68例患者,平均随访189天。胰腺炎最常见的病因是胆结石(35.3%),大多数PFCs是壁状坏死(61.8%),平均大小为14.7厘米(SD±5.9厘米)。总体临床成功率为88.2%,LAMS和DPPS与单独LAMS相比没有显著差异(95.7%vs 84.4%;P=0.18;aOR=4.6;95%CI,0.5-41.4)。我们发现LAMS闭塞率(aOR=0.47;95%CI0.09-2.5)、感染率(aOR=1.03;95%CI0.17-6.2)、出血率(aOR=0.4;95%CI0.03-5)没有统计学显著差异,或支架迁移(aOR=0.42;95%CI,0.04-4.1)。结论这项回顾性队列研究发现,与单独使用LAMS相比,使用LAMS和DPPS进行膀胱造口术的安全性或有效性没有统计学上的显著差异。需要对这些策略进行更大规模的前瞻性试验。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Safety and Efficacy of Lumen-Apposing Metal Stents With and Without Coaxial Plastic Stents for Pancreatic Fluid Collections

Background and Aims

Pancreatic fluid collections (PFCs) are common complications of acute pancreatitis and can cause pain, difficulty feeding, and infection. Endoscopic ultrasound-guided drainage has become the standard of care, with lumen-apposing metal stents (LAMSs) replacing double pigtail plastic stents (DPPSs) as the preferred device. Coaxial placement of DPPSs through LAMSs is hypothesized to lower the risks of adverse events related to LAMSs. We conducted a retrospective study to evaluate the safety and efficacy of this strategy.

Methods

We conducted a retrospective study of consecutive patients with PFCs undergoing endoscopic cystgastrostomy with LAMSs and DPPSs or LAMSs alone at two U.S. academic tertiary care centers from January 2016 until November 2022. Propensity scoring and an adjusted logistic regression model were used for analysis.

Results

We included 68 patients with an average follow-up of 189 days. The most common etiology of pancreatitis was gallstones (35.3%), most PFCs were walled-off necrosis (61.8%), and the mean size was 14.7 cm (SD ± 5.9 cm). Overall clinical success was 88.2%, without significant differences between LAMSs and DPPSs vs LAMSs alone (95.7% vs 84.4%; P = 0.18; aOR = 4.6; 95% CI, 0.5-41.4). We found no statistically significant differences in rates of LAMS occlusion (aOR = 0.47; 95% CI, 0.09-2.5), infection (aOR = 1.03; 95% CI, 0.17-6.2), bleeding (aOR = 0.4; 95% CI, 0.03-5), or stent migration (aOR = 0.42; 95% CI, 0.04-4.1) between the 2 groups.

Conclusion

This retrospective cohort study found no statistically significant differences in the safety or efficacy of cystgastrostomy with LAMSs and DPPSs vs LAMSs alone. Larger, prospective trials comparing these strategies are needed.

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来源期刊
Accounts of Chemical Research
Accounts of Chemical Research 化学-化学综合
CiteScore
31.40
自引率
1.10%
发文量
312
审稿时长
2 months
期刊介绍: Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.
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