Unilateral versus Bilateral Endoscopic Nasobiliary Drainage and Subsequent Metal Stent Placement for Unresectable Malignant Hilar Obstruction: A Multicenter Randomized Controlled Trial

被引：19

作者：

Hakuta, Ryunosuke ^{[1
,2
]}

Kogure, Hirofumi ^{[1
]}

Nakai, Yousuke ^{[1
,2
]}

Kawakami, Hiroshi ^{[3
,4
]}

Maguchi, Hiroyuki ^{[5
]}

Mukai, Tsuyoshi ^{[6
]}

Iwashita, Takuji ^{[7
]}

Saito, Tomotaka ^{[1
,8
]}

Togawa, Osamu ^{[9
]}

Matsubara, Saburo ^{[10
,11
]}

Hayashi, Tsuyoshi ^{[5
,12
]}

Maetani, Iruru ^{[13
]}

Ito, Yukiko ^{[14
]}

Hasebe, Osamu ^{[15
]}

Itoi, Takao ^{[16
]}

Hanada, Keiji ^{[17
]}

Isayama, Hiroyuki ^{[1
,18
]}

机构：

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

[2] Univ Tokyo, Grad Sch Med, Dept Endoscopy & Endoscop Surg, Tokyo 1138655, Japan

[3] Hokkaido Univ, Dept Gastroenterol & Hepatol, Grad Sch Med, Sapporo, Hokkaido 0608648, Japan

[4] Univ Miyazaki, Dept Gastroenterol & Hepatol, Fac Med, Miyazaki 8891692, Japan

[5] Teine Keijinkai Hosp, Ctr Gastroenterol, Sapporo, Hokkaido 0068555, Japan

[6] Gifu Municipal Hosp, Dept Gastroenterol, Gifu 5008513, Japan

[7] Gifu Univ Hosp, Dept Internal Med 1, Gifu 5011194, Japan

[8] JR Tokyo Gen Hosp, Dept Gastroenterol, Tokyo 1518528, Japan

[9] Kanto Cent Hosp, Dept Gastroenterol, Tokyo 1588531, Japan

[10] Tokyo Metropolitan Police Hosp, Dept Gastroenterol, Tokyo 1648541, Japan

[11] Saitama Med Univ, Dept Gastroenterol & Hepatol, Saitama Med Ctr, Saitama 3508550, Japan

[12] Sapporo Med Univ, Dept Med Oncol & Hematol, Sch Med, Sapporo, Hokkaido 0608556, Japan

[13] Toho Univ, Div Gastroenterol & Hepatol, Dept Internal Med, Ohashi Med Ctr, Tokyo 1538515, Japan

[14] Japanese Red Cross Med Ctr, Dept Gastroenterol, Tokyo 1508935, Japan

[15] Nagano Municipal Hosp, Dept Gastroenterol, Nagano 3818551, Japan

[16] Tokyo Med Univ, Dept Gastroenterol & Hepatol, Tokyo 1600023, Japan

[17] Onomichi Gen Hosp, Dept Gastroenterol, Hiroshima 7220018, Japan

[18] Juntendo Univ, Grad Sch Med, Dept Gastroenterol, Tokyo 1138431, Japan

来源：

JOURNAL OF CLINICAL MEDICINE | 2021年 / 10卷 / 02期

关键词：

cholestasis; endoscopic retrograde cholangiopancreatography; endoscopy; jaundice; stents;

D O I：

10.3390/jcm10020206

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

(1) Background: Endoscopic management of hilar biliary obstruction is still challenging. Compared with unilateral drainage, bilateral drainage could preserve larger functional liver volume and potentially improve clinical outcomes. To evaluate the effectiveness of bilateral drainage, we conducted this multicenter randomized controlled study. (2) Methods: Patients with unresectable malignant hilar biliary obstruction were assigned to unilateral or bilateral group. At first, patients underwent endoscopic nasobiliary drainage (ENBD), and subsequently underwent self-expandable metallic stent (SEMS) deployment. Primary outcomes were the functional success rate of ENBD and time to recurrent biliary obstruction (TRBO) after SEMS deployment. (3) Results: During the study period, 38 and 39 patients were enrolled in the unilateral and bilateral groups. The functional success rate was similar in the uni- and bi-ENBD group (57% vs. 56%; p = 0.99), but the rate of additional drainage was higher in uni-ENBD group. Although TRBO and overall survival time after SEMS deployment were not different between the groups (p = 0.11 and 0.78, respectively), the incidence of early adverse events tended to be higher in the bi-SEMS group (5.3% vs. 28%; p = 0.11). (4) Conclusions: Our study failed to demonstrate the superiority of bilateral over unilateral biliary drainage in terms of functional success rate and TRBO.

引用

页码：1 / 11

页数：11

共 28 条

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