BACKGROUND Endoscopic biliary drainage for malignant hilar biliary obstruction(MHBO)remains a highly complex endoscopic retrograde cholangiopancreatography(ERCP)procedure.Each case requires an individualized approach,...BACKGROUND Endoscopic biliary drainage for malignant hilar biliary obstruction(MHBO)remains a highly complex endoscopic retrograde cholangiopancreatography(ERCP)procedure.Each case requires an individualized approach,with outcomes influenced by the expertise of the medical center and access to advanced endoscopic tools.AIM To compare different stent types and drainage strategies,including the use of adjunctive therapies,in patients with MHBO treated endoscopically.METHODS We retrospectively analyzed 164 patients with MHBO(Bismuth types 3–4)who underwent exclusive endoscopic drainage.Patients were grouped by stent type—uncovered self-expandable metal stents(UCSEMS),bilateral plastic stents,or a mixed approach(fully covered self-expandable metal stents+plastic)—as well as by drainage strategy(unilateral/bilateral)and use of radiofrequency ablation(RFA)or chemotherapy.RESULTS Patients receiving UCSEMS had significantly longer overall survival compared to those with plastic stents or the mixed approach(P<0.0001).Mean stent occlusion times were 80 days(bilateral plastic),84.4 days(mixed approach),and 122.5 days(UCSEMS;P<0.0001).The mean number of ERCP reinterventions was highest in the UCSEMS group(5.4)compared to bilateral plastic(2.5)and mixed approach group(4.5;P<0.0001).Patients who received RFA or chemotherapy had significantly longer survival(P<0.0001).CONCLUSION Bilateral UCSEMS stenting appears most effective for palliative treatment of MHBO.Adjunctive use of RFA and chemotherapy may further enhance survival,supporting a personalized,multidisciplinary approach.展开更多
Background:Peripancreatic fluid collections(PFCs)are complications resulting from acute or chronic pancreatitis and require treatment in certain clinical conditions.The present study aimed to identify the factors infl...Background:Peripancreatic fluid collections(PFCs)are complications resulting from acute or chronic pancreatitis and require treatment in certain clinical conditions.The present study aimed to identify the factors influencing the duration of endoscopic ultrasound(EUS)-guided drainage of symptomatic pancreatic pseudocysts(PPCs),walled-off necrosis(WON),and acute necrotic collections(ANCs).Methods:This was a retrospective cohort study of 68 patients with PFCs who underwent EUS-guided drainage.The timing and duration of EUS-guided drainage of various PFCs(ANC,WON,and PPCs)were compared,and the factors influencing the duration of endoscopic treatment were identified.Results:The mean time to first EUS-guided PFC drainage since the acute pancreatitis episode was 372.0,505.0,and 18.7 days for WON,PPC,and ANC,respectively,and the mean duration of treatment was 90,60,and 63 days,respectively.A disconnected pancreatic duct,a history of percutaneous drainage,and an infected PFC were identified as factors influencing the treatment duration.A positive correlation was observed between the treatment duration and patients’age.Patients with a disconnected pancreatic duct had to undergo more procedures.In patients with PPC,clinically successful drainage was more frequently achieved after a single procedure without the need for repeated procedures than in those with WON(90%vs.59%,P=0.01).Conclusions:Patients with a history of percutaneous drainage,disconnected pancreatic duct,or PFC infection may require longer endoscopic treatment.展开更多
文摘BACKGROUND Endoscopic biliary drainage for malignant hilar biliary obstruction(MHBO)remains a highly complex endoscopic retrograde cholangiopancreatography(ERCP)procedure.Each case requires an individualized approach,with outcomes influenced by the expertise of the medical center and access to advanced endoscopic tools.AIM To compare different stent types and drainage strategies,including the use of adjunctive therapies,in patients with MHBO treated endoscopically.METHODS We retrospectively analyzed 164 patients with MHBO(Bismuth types 3–4)who underwent exclusive endoscopic drainage.Patients were grouped by stent type—uncovered self-expandable metal stents(UCSEMS),bilateral plastic stents,or a mixed approach(fully covered self-expandable metal stents+plastic)—as well as by drainage strategy(unilateral/bilateral)and use of radiofrequency ablation(RFA)or chemotherapy.RESULTS Patients receiving UCSEMS had significantly longer overall survival compared to those with plastic stents or the mixed approach(P<0.0001).Mean stent occlusion times were 80 days(bilateral plastic),84.4 days(mixed approach),and 122.5 days(UCSEMS;P<0.0001).The mean number of ERCP reinterventions was highest in the UCSEMS group(5.4)compared to bilateral plastic(2.5)and mixed approach group(4.5;P<0.0001).Patients who received RFA or chemotherapy had significantly longer survival(P<0.0001).CONCLUSION Bilateral UCSEMS stenting appears most effective for palliative treatment of MHBO.Adjunctive use of RFA and chemotherapy may further enhance survival,supporting a personalized,multidisciplinary approach.
基金supported by statutory activity of the Medical University of Warsaw,Poland。
文摘Background:Peripancreatic fluid collections(PFCs)are complications resulting from acute or chronic pancreatitis and require treatment in certain clinical conditions.The present study aimed to identify the factors influencing the duration of endoscopic ultrasound(EUS)-guided drainage of symptomatic pancreatic pseudocysts(PPCs),walled-off necrosis(WON),and acute necrotic collections(ANCs).Methods:This was a retrospective cohort study of 68 patients with PFCs who underwent EUS-guided drainage.The timing and duration of EUS-guided drainage of various PFCs(ANC,WON,and PPCs)were compared,and the factors influencing the duration of endoscopic treatment were identified.Results:The mean time to first EUS-guided PFC drainage since the acute pancreatitis episode was 372.0,505.0,and 18.7 days for WON,PPC,and ANC,respectively,and the mean duration of treatment was 90,60,and 63 days,respectively.A disconnected pancreatic duct,a history of percutaneous drainage,and an infected PFC were identified as factors influencing the treatment duration.A positive correlation was observed between the treatment duration and patients’age.Patients with a disconnected pancreatic duct had to undergo more procedures.In patients with PPC,clinically successful drainage was more frequently achieved after a single procedure without the need for repeated procedures than in those with WON(90%vs.59%,P=0.01).Conclusions:Patients with a history of percutaneous drainage,disconnected pancreatic duct,or PFC infection may require longer endoscopic treatment.
