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Optimal stent placement strategy for malignant hilar biliary obstruction: a large multicenter parallel study.
Gastrointestinal Endoscopy ( IF 6.7 ) Pub Date : 2019-12-25 , DOI: 10.1016/j.gie.2019.12.023 Ming-Xing Xia 1 , Xiao-Bo Cai 2 , Yang-Lin Pan 3 , Jun Wu 4 , Dao-Jian Gao 1 , Xin Ye 1 , Tian-Tian Wang 1 , Bing Hu 5
Gastrointestinal Endoscopy ( IF 6.7 ) Pub Date : 2019-12-25 , DOI: 10.1016/j.gie.2019.12.023 Ming-Xing Xia 1 , Xiao-Bo Cai 2 , Yang-Lin Pan 3 , Jun Wu 4 , Dao-Jian Gao 1 , Xin Ye 1 , Tian-Tian Wang 1 , Bing Hu 5
Affiliation
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BACKGROUND AND AIMS
The endoscopic management of malignant hilar biliary obstruction (MHBO) remains extremely challenging without universal consensus. For the first time, we compared 4 major modalities aiming to determine the optimal strategy.
METHODS
We reviewed 1239 patients with advanced MHBO who underwent endoscopic stent placement as the primary treatment in 4 tertiary centers. Among them, 633 eligible patients were identified and classified into 4 groups: bilateral metal stent placement (BMS), unilateral metal stent placement (UMS), bilateral plastic stent placement (BPS), and unilateral plastic stent placement (UPS). The outcomes were compared before and after propensity score matching (PSM).
RESULTS
After PSM, 87, 97, 91, and 81 patients in the BMS, UMS, BPS, and UPS groups, respectively, were matched. The clinical success rates were 98.9%, 83.5%, 71.4%, and 65.4% in the BMS, UMS, BPS, and UPS groups (P < .001), respectively. The postprocedural cholangitis rates were 8.0%, 17.5%, 26.4%, and 29.6% (P = .002), respectively. The median symptom-free stent patency was 9.6, 6.8, 4.6, and 4.2 months (P < .001), respectively. The mean number of interventions required was 1.2 ± 0.5, 1.7 ± 0.8, 2.0 ± 1.4, and 1.9 ± 1.3 (P < .001), respectively. The median (95% confidence interval) overall survival (OS) was 7.1 (6.0-8.2), 4.4 (3.8-4.9), 4.1 (2.9-5.2), and 2.7 (1.8-3.7) months (P = .001), respectively. Compared with plastic stent placement, metal stent placement achieved higher success in all outcome parameters (P ≤ .001). Bilateral stent placement was superior to unilateral stent placement in terms of clinical success (P = .024), stent patency (P = .018), and OS (P = .040).
CONCLUSIONS
If technically possible, dual metal stent placement is a preferred palliation for inoperable MHBO, and unilateral metal stent placement is the second option.
中文翻译：
恶性肝门胆道梗阻的最佳支架置入策略：大型多中心平行研究。
背景与目的内镜下恶性肝门胆管梗阻（MHBO）的管理在没有普遍共识的情况下仍然极具挑战性。首次，我们比较了旨在确定最佳策略的4种主要方式。方法我们回顾了在4个三级中心接受内镜支架置入术的1239例晚期MHBO患者。其中，确定了633名合格患者，并将其分为4组：双侧金属支架放置（BMS），单侧金属支架放置（UMS），双侧塑料支架放置（BPS）和单侧塑料支架放置（UPS）。比较倾向评分匹配（PSM）前后的结果。结果PSM后，分别对BMS，UMS，BPS和UPS组的87、97、91和81例患者进行了匹配。临床成功率为98。在BMS，UMS，BPS和UPS组中，分别为9％，83.5％，71.4％和65.4％（P <.001）。术后胆管炎发生率分别为8.0％，17.5％，26.4％和29.6％（P = 0.002）。无症状支架的中位通畅时间分别为9.6、6.8、4.6和4.2个月（P <.001）。所需的平均干预次数分别为1.2±0.5、1.7±0.8、2.0±1.4和1.9±1.3（P <.001）。中位数（95％置信区间）总生存期（OS）为7.1（6.0-8.2），4.4（3.8-4.9），4.1（2.9-5.2）和2.7（1.8-3.7）个月（P = .001），分别。与塑料支架置入相比，金属支架置入在所有结果参数上均取得了较高的成功率（P≤.001）。就临床成功率（P = .024），支架通畅性（P = .018）和OS（P = .040）而言，双侧支架置入优于单侧支架置入。
更新日期：2019-12-25
中文翻译：
恶性肝门胆道梗阻的最佳支架置入策略：大型多中心平行研究。
背景与目的内镜下恶性肝门胆管梗阻（MHBO）的管理在没有普遍共识的情况下仍然极具挑战性。首次，我们比较了旨在确定最佳策略的4种主要方式。方法我们回顾了在4个三级中心接受内镜支架置入术的1239例晚期MHBO患者。其中，确定了633名合格患者，并将其分为4组：双侧金属支架放置（BMS），单侧金属支架放置（UMS），双侧塑料支架放置（BPS）和单侧塑料支架放置（UPS）。比较倾向评分匹配（PSM）前后的结果。结果PSM后，分别对BMS，UMS，BPS和UPS组的87、97、91和81例患者进行了匹配。临床成功率为98。在BMS，UMS，BPS和UPS组中，分别为9％，83.5％，71.4％和65.4％（P <.001）。术后胆管炎发生率分别为8.0％，17.5％，26.4％和29.6％（P = 0.002）。无症状支架的中位通畅时间分别为9.6、6.8、4.6和4.2个月（P <.001）。所需的平均干预次数分别为1.2±0.5、1.7±0.8、2.0±1.4和1.9±1.3（P <.001）。中位数（95％置信区间）总生存期（OS）为7.1（6.0-8.2），4.4（3.8-4.9），4.1（2.9-5.2）和2.7（1.8-3.7）个月（P = .001），分别。与塑料支架置入相比，金属支架置入在所有结果参数上均取得了较高的成功率（P≤.001）。就临床成功率（P = .024），支架通畅性（P = .018）和OS（P = .040）而言，双侧支架置入优于单侧支架置入。
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