One- and two-step self-expandable metal stent placement for distal malignant biliary obstruction: a propensity analysis

被引：7

作者：

Hamada, Tsuyoshi ^{[1
,2
]}

Nakai, Yousuke ^{[1
]}

Isayama, Hiroyuki ^{[1
]}

Togawa, Osamu ^{[3
]}

Kogure, Hirofumi ^{[1
]}

Kawakubo, Kazumichi ^{[1
]}

Tsujino, Takeshi ^{[2
]}

Sasahira, Naoki ^{[1
]}

Hirano, Kenji ^{[1
]}

Yamamoto, Natsuyo ^{[1
]}

Ito, Yukiko ^{[2
]}

Sasaki, Takashi ^{[1
]}

Mizuno, Suguru ^{[4
]}

Toda, Nobuo ^{[5
]}

Tada, Minoru ^{[1
]}

Koike, Kazuhiko ^{[1
]}

机构：

[1] Univ Tokyo, Grad Sch Med, Dept Gastroenterol, Bunkyo Ku, Tokyo 1138655, Japan

[2] Japanese Red Cross Med Ctr, Dept Gastroenterol, Tokyo, Japan

[3] JR Tokyo Gen Hosp, Dept Gastroenterol, Tokyo, Japan

[4] Kanto Cent Hosp, Dept Gastroenterol, Tokyo, Japan

[5] Mitsui Mem Hosp, Dept Gastroenterol, Tokyo 101, Japan

来源：

JOURNAL OF GASTROENTEROLOGY | 2012年 / 47卷 / 11期

关键词：

Distal malignant biliary obstruction; Self-expandable metal stent; One-step; Two-step; Propensity analysis; FINE-NEEDLE-ASPIRATION; SUSPECTED PANCREATIC-CANCER; COMMON BILE-DUCT; ENDOSCOPIC ULTRASOUND; RANDOMIZED-TRIAL; PREOPERATIVE EVALUATION; COMPUTED-TOMOGRAPHY; COVERED WALLSTENT; FORCEPS BIOPSY; BRUSH CYTOLOGY;

D O I：

10.1007/s00535-012-0582-3

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Although self-expandable metal stents (SEMS) are widely used for distal malignant biliary obstruction, one-step SEMS (direct placement without a prior plastic stent) and two-step SEMS (placement at second endoscopic retrograde cholangiopancreatography [ERCP] following plastic stent placement) have not been fully compared. In this multicenter retrospective study, patients were included who underwent first-time endoscopic SEMS placement between September 1994 and December 2010. We compared the one-step and two-step strategies using a propensity analysis. In total, 370 patients were identified and one-step SEMS was performed in 59 patients. After adjustment using propensity scores, the median times to dysfunction were 116 and 219 days, respectively, for one-step and two-step SEMS (P = 0.058). Stent migration was more frequently observed in one-step SEMS as compared with two-step SEMS (25 vs. 11 %, P = 0.031). In one-step SEMS, the number of days of hospitalization associated with first-time SEMS placement was shorter compared with that in two-step SEMS (21 vs. 30 days, P = 0.001), and the total costs of SEMS-related interventions within 6 months were lower (6510 and 8100 USD, P = 0.004). The pathological diagnosis rates for pancreatic and biliary tract cancer at initial ERCP were 52 and 61 %. After failed diagnosis at initial ERCP, pathological diagnosis rates for pancreatic cancer were 32 versus 76 % (P = 0.005) by repeated ERCP versus endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA). One-step SEMS was associated with increased stent migration, despite having potential cost-effectiveness. The additional yield of pathological diagnosis at repeated ERCP was low compared with that yielded by EUS-guided FNA.

引用

页码：1248 / 1256

页数：9

共 45 条

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