Multicenter study of endoscopic preoperative biliary drainage for malignant hilar biliary obstruction: E-POD hilar study

被引：37

作者：

Nakai, Yousuke ^{[1
]}

Yamamoto, Ryuichi ^{[17
]}

Matsuyama, Masato ^{[2
]}

Sakai, Yuji ^{[20
]}

Takayama, Yukiko ^{[3
]}

Ushio, Jun ^{[23
]}

Ito, Yukiko ^{[4
]}

Kitamura, Katsuya ^{[5
]}

Ryozawa, Shomei ^{[18
]}

Imamura, Tsunao ^{[6
]}

Tsuchida, Kouhei ^{[24
]}

Hayama, Jo ^{[7
]}

Itoi, Takao ^{[8
]}

Kawaguchi, Yoshiaki ^{[25
]}

Yoshida, Yu ^{[21
]}

Sugimori, Kazuya ^{[26
]}

Shimura, Kenji ^{[22
]}

Mizuide, Masafumi ^{[30
]}

Iwai, Tomohisa ^{[28
]}

Nishikawa, Ko ^{[19
]}

Yagioka, Hiroshi ^{[9
]}

Nagahama, Masatsugu ^{[27
]}

Toda, Nobuo ^{[10
]}

Saito, Tomotaka ^{[11
]}

Yasuda, Ichiro ^{[29
]}

Hirano, Kenji ^{[12
]}

Togawa, Osamu ^{[13
]}

Nakamura, Kenji ^{[14
]}

Maetani, Iruru ^{[15
]}

Sasahira, Naoki ^{[2
]}

Isayama, Hiroyuki ^{[1
,16
]}

机构：

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

[2] Japanese Fdn Canc Res, Dept Gastroenterol, Canc Inst Hosp, Tokyo, Japan

[3] Tokyo Womens Med Univ, Inst Gastroenterol, Tokyo, Japan

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

[5] Showa Univ, Div Gastroenterol, Dept Med, Sch Med, Tokyo, Japan

[6] Toranomon Gen Hosp, Dept Gastroenterol, Tokyo, Japan

[7] Nihon Univ, Dept Gastroenterol & Hepatol, Itabashi Hosp, Tokyo, Japan

[8] Tokyo Med Univ, Dept Gastroenterol & Hepatol, Tokyo, Japan

[9] Tokyo Metropolitan Police Hosp, Dept Gastroenterol, Tokyo, Japan

[10] Mitsui Mem Hosp, Dept Gastroenterol, Tokyo, Japan

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

[12] JHCO Tokyo Takanawa Hosp, Dept Gastroenterol, Tokyo, Japan

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

[14] St Lukes Int Hosp, Dept Gastroenterol, Tokyo, Japan

[15] Toho Univ, Div Gastroenterol & Hepatol, Dept Internal Med, Ohashi Med Ctr, Tokyo, Japan

[16] Juntendo Univ, Grad Sch Med, Dept Gastroenterol, Tokyo, Japan

[17] Saitama Med Univ, Saitama Med Ctr, Dept Gastroenterol & Hepatol, Saitama, Japan

[18] Saitama Med Univ, Int Med Ctr, Dept Gastroenterol, Saitama, Japan

[19] Ageo Cent Gen Hosp, Dept Gastroenterol, Saitama, Japan

[20] Chiba Univ, Grad Sch Med, Dept Gastroenterol & Nephrol, Chiba, Japan

[21] Kimitsu Chuo Hosp, Dept Gastroenterol, Chiba, Japan

[22] Asahi Gen Hosp, Dept Gastroenterol, Chiba, Japan

[23] Jichi Med Univ Hosp, Dept Gastroenterol, Shimotsuke, Japan

[24] Dokkyo Med Univ, Dept Gastroenterol, Mibu, Tochigi, Japan

[25] Tokai Univ, Sch Med, Dept Gastroenterol, Tokai, Ibaraki, Japan

[26] Yokohama City Univ, Med Ctr, Gastroenterol Ctr, Yokohama, Kanagawa, Japan

[27] Showa Univ, Fujigaoka Hosp, Dept Gastroenterol, Yokohama, Kanagawa, Japan

[28] Kitasato Univ Hosp, Dept Gastroenterol, Sagamihara, Kanagawa, Japan

[29] Teikyo Univ, Mizonokuchi Hosp, Dept Gastroenterol, Kawasaki, Kanagawa, Japan

[30] Gunma Univ Hosp, Dept Gastroenterol, Maebashi, Gunma, Japan

来源：

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY | 2018年 / 33卷 / 05期

关键词：

endoscopic retrograde cholangiography; hilar tumor; malignant biliary obstruction; preoperative biliary drainage; BILE-DUCT CANCER; NASOBILIARY DRAINAGE; CHOLANGIOCARCINOMA; SPHINCTEROTOMY; MANAGEMENT; RESECTION; BENEFIT; RISK;

D O I：

10.1111/jgh.14050

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background and AimEndoscopic nasobiliary drainage (ENBD) is often recommended in preoperative biliary drainage (PBD) for hilar malignant biliary obstruction (MBO), but endoscopic biliary stent (EBS) is also used in the clinical practice. We conducted this large-scale multicenter study to compare ENBD and EBS in this setting. MethodsA total of 374 cases undergoing PBD including 281 ENBD and 76 EBS for hilar MBO in 29 centers were retrospectively studied. ResultsExtrahepatic cholangiocarcinoma (ECC) accounted for 69.8% and Bismuth-Corlette classification was III or more in 58.8% of the study population. Endoscopic PBD was technically successful in 94.6%, and adverse event rate was 21.9%. The rate of post-endoscopic retrograde cholangiopancreatography pancreatitis was 16.0%, and non-endoscopic sphincterotomy was the only risk factor (odds ratio [OR] 2.51). Preoperative re-intervention was performed in 61.5%: planned re-interventions in 48.4% and unplanned re-interventions in 31.0%. Percutaneous transhepatic biliary drainage was placed in 6.4% at the time of surgery. The risk factors for unplanned procedures were ECC (OR 2.64) and total bilirubin 10mg/dL (OR 2.18). In surgically resected cases, prognostic factors were ECC (hazard ratio [HR] 0.57), predraiange magnetic resonance cholangiopancreatography (HR 1.62) and unplanned re-interventions (HR 1.81). EBS was not associated with increased adverse events, unplanned re-interventions, or a poor prognosis. ConclusionsOur retrospective analysis did not demonstrate the advantage of ENBD over EBS as the initial PBD for resectable hilar MBO. Although the technical success rate of endoscopic PBD was high, its re-intervention rate was not negligible, and unplanned re-intervention was associated with a poor prognosis in resected hilar MBO.

引用

页码：1146 / 1153

页数：8

共 22 条

[1] MANAGEMENT STRATEGIES IN RESECTION FOR HILAR CHOLANGIOCARCINOMA [J].