BACKGROUND Studies have shown that covered self-expandable metallic stents(CSEMS)with a low axial forces after placement can cause early recurrent biliary obstruction(RBO)due to precipitating sludge formation.AIM To a...BACKGROUND Studies have shown that covered self-expandable metallic stents(CSEMS)with a low axial forces after placement can cause early recurrent biliary obstruction(RBO)due to precipitating sludge formation.AIM To ascertain whether the angle of CSEMS after placement is a risk factor for RBO in unresectable distal malignant biliary obstruction(MBO).METHODS Between January 2010 and March 2019,261 consecutive patients underwent selfexpandable metallic stent insertion by endoscopic retrograde cholangiopancreatography at our facility,and 87 patients were included in this study.We evaluated the risk factors for RBO,including the angle of CSEMS after placement as the primary outcome.We measured the obtuse angle of CSEMS after placement on an abdominal radiograph using the SYNAPSE PACS system.We also evaluated technical and functional success,adverse events,time to RBO(TRBO),non-RBO rate,survival time,cause of RBO,and reintervention procedure as secondary outcomes.RESULTS We divided the patients into two cohorts based on the presence or absence of RBO.The angle of CSEMS after placement(per 1°and per 10°)was evaluated using the multivariate Cox proportional hazard analysis,which was an independent risk factor for RBO in unresectable distal MBO[hazard ratio,0.97 and 0.71;95%confidence interval(CI):0.94-0.99 and 0.54-0.92;P=0.01 and 0.01,respectively].For early diagnosis of RBO,the cut-off value of the angle of CSEMS after placement using the receiver operating characteristic curve was 130°[sensitivity,50.0%;specificity 85.5%;area under the curve 0.70(95%CI:0.57-0.84)].TRBO in the<130°angle group was significantly shorter than that in the≥130°angle group(P<0.01).CONCLUSION This study suggests that the angle of the CSEMS after placement for unresectable distal MBO is a risk factor for RBO.These novel results provide pertinent information for future stent management.展开更多
BACKGROUND Endoscopic ultrasound(EUS)-guided biliary drainage(BD)is becoming more common as a secondary drainage method in cases of difficult endoscopic retrograde cholangiopancreatography.In a recent study,EUS-BD rep...BACKGROUND Endoscopic ultrasound(EUS)-guided biliary drainage(BD)is becoming more common as a secondary drainage method in cases of difficult endoscopic retrograde cholangiopancreatography.In a recent study,EUS-BD reportedly demonstrated similar safety between elderly patients and all other patients.However,the appropriate stent for placement in elderly patients is unknown.AIM To clarify whether a metallic stent(MS)or a plastic stent(PS)is suitable when performing EUS-BD in elderly patients.METHODS This was a multicenter retrospective study of patients who underwent EUS-BD between March 2005 and February 2025.The data of patients aged 70 years or older who underwent successful EUS-BD were analyzed,and the longterm outcomes of patients treated with an MS(MS group)and those treated with a PS(PS group)were compared.RESULTS Ninety-four patients underwent successful EUS-BD,of whom 64 were aged 70 years or older.The PS group included 51 patients,and the MS group included 13 patients.The time to recurrent biliary obstruction(TRBO)was not significantly different between the PS group and the MS group(6-month recurrent biliary obstruction rate 50.8%vs 26.8%,P=0.18).When patients were limited to those with malignancies without antegrade stenting,the TRBO was significantly longer in the MS group than in the PS group(6-month recurrent biliary obstruction rate 63.3%vs 20.7%,P=0.036).CONCLUSION A PS might be sufficient for performing EUS-BD in elderly patients aged 70 years or older with benign biliary disease because it is easily replaced.However,an MS might be more effective for elderly individuals with malignant biliary obstruction because of the expectation of a longer TRBO and a reduced need for stent replacement.展开更多
文摘BACKGROUND Studies have shown that covered self-expandable metallic stents(CSEMS)with a low axial forces after placement can cause early recurrent biliary obstruction(RBO)due to precipitating sludge formation.AIM To ascertain whether the angle of CSEMS after placement is a risk factor for RBO in unresectable distal malignant biliary obstruction(MBO).METHODS Between January 2010 and March 2019,261 consecutive patients underwent selfexpandable metallic stent insertion by endoscopic retrograde cholangiopancreatography at our facility,and 87 patients were included in this study.We evaluated the risk factors for RBO,including the angle of CSEMS after placement as the primary outcome.We measured the obtuse angle of CSEMS after placement on an abdominal radiograph using the SYNAPSE PACS system.We also evaluated technical and functional success,adverse events,time to RBO(TRBO),non-RBO rate,survival time,cause of RBO,and reintervention procedure as secondary outcomes.RESULTS We divided the patients into two cohorts based on the presence or absence of RBO.The angle of CSEMS after placement(per 1°and per 10°)was evaluated using the multivariate Cox proportional hazard analysis,which was an independent risk factor for RBO in unresectable distal MBO[hazard ratio,0.97 and 0.71;95%confidence interval(CI):0.94-0.99 and 0.54-0.92;P=0.01 and 0.01,respectively].For early diagnosis of RBO,the cut-off value of the angle of CSEMS after placement using the receiver operating characteristic curve was 130°[sensitivity,50.0%;specificity 85.5%;area under the curve 0.70(95%CI:0.57-0.84)].TRBO in the<130°angle group was significantly shorter than that in the≥130°angle group(P<0.01).CONCLUSION This study suggests that the angle of the CSEMS after placement for unresectable distal MBO is a risk factor for RBO.These novel results provide pertinent information for future stent management.
文摘BACKGROUND Endoscopic ultrasound(EUS)-guided biliary drainage(BD)is becoming more common as a secondary drainage method in cases of difficult endoscopic retrograde cholangiopancreatography.In a recent study,EUS-BD reportedly demonstrated similar safety between elderly patients and all other patients.However,the appropriate stent for placement in elderly patients is unknown.AIM To clarify whether a metallic stent(MS)or a plastic stent(PS)is suitable when performing EUS-BD in elderly patients.METHODS This was a multicenter retrospective study of patients who underwent EUS-BD between March 2005 and February 2025.The data of patients aged 70 years or older who underwent successful EUS-BD were analyzed,and the longterm outcomes of patients treated with an MS(MS group)and those treated with a PS(PS group)were compared.RESULTS Ninety-four patients underwent successful EUS-BD,of whom 64 were aged 70 years or older.The PS group included 51 patients,and the MS group included 13 patients.The time to recurrent biliary obstruction(TRBO)was not significantly different between the PS group and the MS group(6-month recurrent biliary obstruction rate 50.8%vs 26.8%,P=0.18).When patients were limited to those with malignancies without antegrade stenting,the TRBO was significantly longer in the MS group than in the PS group(6-month recurrent biliary obstruction rate 63.3%vs 20.7%,P=0.036).CONCLUSION A PS might be sufficient for performing EUS-BD in elderly patients aged 70 years or older with benign biliary disease because it is easily replaced.However,an MS might be more effective for elderly individuals with malignant biliary obstruction because of the expectation of a longer TRBO and a reduced need for stent replacement.
