Abstract：
OBJECTIVE: Unresectable ampullary cancer (AC) is a rare disease entity. The risk factors for recurrent biliary obstruction (RBO) following endoscopic biliary stenting (EBS) for unresectable AC remain unknown. In this study we aimed to evaluate the cumulative RBO rate and to identify risk factors for RBO following palliative EBS in patients with unresectable AC.
METHODS: This multicenter retrospective observational study enrolled consecutive patients with unresectable AC who had undergone palliative EBS between April 2011 and December 2021. The cumulative rate of and risk factors for RBO following palliative EBS were evaluated via multivariate analysis.
RESULTS: The study analysis comprised 107 patients with a median age of 84 years (interquartile range 79-88 years). Plastic stents (PSs) and self-expandable metal stents (SEMSs) were placed in 53 and 54 patients, respectively. Functional success was accomplished in 104 (97.2%) patients. Of these, RBO occurred in 62 (59.6%) patients, with obstruction and complete/partial migration occurring in 47 and 15 patients, respectively. The median time to RBO was 190 days. Multivariate analysis showed that PS was associated with a higher rate of RBO compared to SEMS (hazard ratio [HR] 2.48; P < 0.01) and that the presence of common bile duct stones/sludge immediately after EBS was an independent risk factor for RBO (HR 1.99; P = 0.04).
CONCLUSIONS: The use of SEMS compared to PS during EBS reduced the time to RBO in patients with unresectable AC. Common bile duct stones/sludge immediately after EBS was a risk factor for RBO.
METHODS: This multicenter retrospective observational study enrolled consecutive patients with unresectable AC who had undergone palliative EBS between April 2011 and December 2021. The cumulative rate of and risk factors for RBO following palliative EBS were evaluated via multivariate analysis.
RESULTS: The study analysis comprised 107 patients with a median age of 84 years (interquartile range 79-88 years). Plastic stents (PSs) and self-expandable metal stents (SEMSs) were placed in 53 and 54 patients, respectively. Functional success was accomplished in 104 (97.2%) patients. Of these, RBO occurred in 62 (59.6%) patients, with obstruction and complete/partial migration occurring in 47 and 15 patients, respectively. The median time to RBO was 190 days. Multivariate analysis showed that PS was associated with a higher rate of RBO compared to SEMS (hazard ratio [HR] 2.48; P < 0.01) and that the presence of common bile duct stones/sludge immediately after EBS was an independent risk factor for RBO (HR 1.99; P = 0.04).
CONCLUSIONS: The use of SEMS compared to PS during EBS reduced the time to RBO in patients with unresectable AC. Common bile duct stones/sludge immediately after EBS was a risk factor for RBO.
摘要：
目的：不可切除壶腹癌（AC）是一种罕见的疾病。内镜胆道支架置入术（EBS）治疗无法切除的AC后复发性胆道梗阻（RBO）的危险因素尚不清楚。在这项研究中，我们旨在评估不可切除的AC患者姑息性EBS后的累积RBO率并确定RBO的危险因素。
方法：这项多中心回顾性观察研究连续纳入2011年4月至2021年12月期间接受姑息性EBS治疗的不可切除AC患者。通过多变量分析评估姑息性EBS后RBO的累积率和危险因素。
结果：研究分析包括107例患者，中位年龄为84岁（四分位距79-88岁）。在53和54例患者中放置了塑料支架（PS）和自膨胀金属支架（SEMS），分别。104例（97.2%）患者获得功能成功。其中,RBO发生在62例（59.6%）患者中，在47和15例患者中发生阻塞和完全/部分迁移，分别。RBO的中位时间为190天。多因素分析显示，与SEMS相比，PS与RBO的发生率更高（风险比[HR]2.48；P<0.01），并且EBS后立即出现胆总管结石/污泥是RBO的独立危险因素（HR1.99；P=0.04）。
结论：在EBS期间使用SEMS与PS相比减少了不可切除AC患者的RBO时间。EBS后立即胆总管结石/污泥是RBO的危险因素。
方法：这项多中心回顾性观察研究连续纳入2011年4月至2021年12月期间接受姑息性EBS治疗的不可切除AC患者。通过多变量分析评估姑息性EBS后RBO的累积率和危险因素。
结果：研究分析包括107例患者，中位年龄为84岁（四分位距79-88岁）。在53和54例患者中放置了塑料支架（PS）和自膨胀金属支架（SEMS），分别。104例（97.2%）患者获得功能成功。其中,RBO发生在62例（59.6%）患者中，在47和15例患者中发生阻塞和完全/部分迁移，分别。RBO的中位时间为190天。多因素分析显示，与SEMS相比，PS与RBO的发生率更高（风险比[HR]2.48；P<0.01），并且EBS后立即出现胆总管结石/污泥是RBO的独立危险因素（HR1.99；P=0.04）。
结论：在EBS期间使用SEMS与PS相比减少了不可切除AC患者的RBO时间。EBS后立即胆总管结石/污泥是RBO的危险因素。
