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Gastroenterology Report 2023年第1期11卷 151-158页

作者： Jiangning Gu Xiaoyi Guo Yong Sun Bin Fan Haoran Li Ting Luo Haifeng Luo Jiao Liu Feng Gao Yuan Gao Guang Tan Xiaoming Liu Zhuo Yang Department of Endoscope General Hospital of Northern Theater CommandShenyangLiaoningP.R.China Department of Hepatobiliary Surgery The First affiliated Hospital of Dalian Medical UniversityDalianLiaoningP.R.China Department of General Surgery The First Hospital of Northwest University(Xi’an No.1 Hospital)Xi’anShaanxiP.R.China Department of Anesthesiology The First affiliated Hospital of Dalian Medical UniversityDalianLiaoningChina

Obstructive jaundice caused by malignant distal biliary obstruction is a common clinical symptom in patients with inoperable biliary–pancreatic *** retrograde cholangiopancreatography(ERCP)-guided stent implantation is an effective treatment for obstructive *** stent drainage is more physiologic and associated with a better quality of life than external stent drainage methods such as percutaneous transhepatic gallbladder drainage or percutaneous transhepatic *** metallic stents,which may be covered and uncovered,are commonly ***,some uncertainties remain regarding the selection of metallic stents,including drainage patency time,clinical effect,stent migration,and post-operative complications such as pancreatitis,bleeding,and *** review aims to summarize the current progress and controversies surrounding the use of covered or uncovered metallic stents in inoperable common biliary obstruction via ERCP.

关键词： malignant distal biliary obstruction ERCP metallic stents USEMS CSEMS

outcomes of preoperative endoscopic nasobiliary drainage and endoscopic retrograde biliary drainage for malignant distal biliary obstruction prior to pancreaticoduodenectomy

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World Journal of Gastroenterology 2017年第29期23卷 5386-5394页

作者： guo-qiang zhang yong li yu-ping ren nan-tao fu hai-bing chen jun-wu yang wei-dong xiao Department of General Surgery the First Affiliated Hospital of Nanchang University

AIM to compare the outcomes of preoperative endoscopic nasobiliary drainage (ENBD) and endoscopic retrograde biliary drainage (ERBD) in patients with malignant distal biliary obstruction prior to pancreaticoduodenectomy (PD). METHODS Data from 153 consecutive patients who underwent preoperative endoscopic biliary drainage prior to PD between January 2009 and July 2016 were analyzed. We compared the clinical data, procedure-related complications of endoscopic biliary drainage (EBD) and postoperative complications of PD between the ENBD and ERBD groups. Univariate and multivariate analyses with odds ratios (ORs) and 95% confidence intervals (95% CIs) were used to identify the risk factors for deep abdominal infection after PD. RESULTS One hundred and two (66.7%) patients underwent ENBD, and 51 (33.3%) patients underwent ERBD. Endoscopic sphincterotomy was less frequently performed in the ENBD group than in the ERBD group (P = 0.039); the EBD duration in the ENBD group was shorter than that in the ERBD group (P = 0.036). After EBD, the levels of total bilirubin (TB) and alanine aminotransferase (ALT) were obviously decreased in both groups, and the decreases of TB and ALT in the ERBD group were greater than those in the ENBD group (P = 0.004 and P = 0.000, respectively). However, the rate of EBD procedure-related cholangitis was significantly higher in the ERBD group than in the ENBD group (P = 0.007). The postoperative complications of PD as graded by the Clavien-Dindo classification system were not significantly different between the two groups (P = 0.864). However, the incidence of deep abdominal infection after PD was significantly lower in the ENBD group than in the ERBD group (P = 0.019). Male gender (OR = 3.92; 95% CI: 1.63-9.47; P = 0.002), soft pancreas texture (OR = 3.60; 95% CI: 1.37-9.49; P = 0.009), length of biliary stricture (= 1.5 cm) (OR = 5.20; 95% CI: 2.23-12.16; P = 0.000) and ERBD method (OR = 4.08; 95% CI: 1.69-9.87; P = 0.002) were independent ri

关键词： preoperative endoscopic biliary drainage endoscopic nasobiliary drainage endoscopic retrograde biliary drainage pancreaticoduodenectomy malignant distal biliary obstruction

Multicenter study of endoscopic preoperative biliary drainage for malignant distal biliary obstruction

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World Journal of Gastroenterology 2016年第14期22卷 3793-3802页

作者： Naoki Sasahira Tsuyoshi Hamada Osamu Togawa Ryuichi Yamamoto Tomohisa Iwai Kiichi Tamada Yoshiaki Kawaguchi Kenji Shimura Takero Koike Yu Yoshida Kazuya Sugimori Shomei Ryozawa Toshiharu Kakimoto Ko Nishikawa Katsuya Kitamura Tsunao Imamura Masafumi Mizuide Nobuo Toda Iruru Maetani Yuji Sakai Takao Itoi Masatsugu Nagahama Yousuke Nakai Hiroyuki Isayama Department of Gastroenterology JCHO Tokyo Takanawa HospitalTokyo 108-8606Japan Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Department of Gastroenterology Saitama International Medical CenterSaitama Medical UniversitySaitama 350-1298Japan Department of Gastroenterology and Hepatology Saitama Medical University International Medical CenterSaitama 350-8550Japan Department of Gastroenterology Kitasato UniversityKanagawa 252-0375Japan Department of Gastroenterology Jichi Medical UniversityTochigi 329-0498Japan Department of Gastroenterology Tokai UniversityKanagawa 259-1193Japan Department of Gastroenterology Asahi General HospitalChiba 289-2511Japan Department of Internal Medicine Japanese Red Cross Ashikaga HospitalTochigi 326-0843Japan Department of Gastroenterology Kimitsu Central HospitalChiba 292-8535Japan Department of Gastroenterology Yokohama City University Medical CenterKanagawa 232-0024Japan Department of Gastroenterology Showa University Northern Yokohama HospitalKanagawa 242-0032Japan Department of Gastroenterology Saitama City HospitalSaitama 336-8522Japan Department of Gastroenterology Ageo Central General HospitalSaitama 362-8588Japan Division of Gastroenterology Department of MedicineShowa University School of MedicineTokyo 142-8666Japan Department of Gastroenterology Toranomon HospitalTokyo 105-0001Japan Department of Gastroenterology Gunma UniversityGunma 371-0034Japan Department of Gastroenterology Mitsui Memorial HospitalTokyo 101-8643Japan Division of Gastroenterology and Hepatology Department of Internal MedicineToho University Ohashi Medical CenterTokyo 153-0044Japan Department of Gastroenterology Chiba UniversityChiba 260-0856Japan Department of Gastroenterology Tokyo Medical UniversityTokyo 160-0023Japan Department of Gastroenterology Showa University Fujigaoka HospitalKanagawa 227-8501Japan

AIM: To determine the optimal method of endoscopic preoperative biliary drainage for malignant distal biliary ***: Multicenter retrospective study was conducted in patients who underwent plastic stent (PS) or nasobiliary catheter (NBC) placement for resectable malignant distal biliary obstruction followed by surgery between January 2010 and March 2012. Procedure-related adverse events, stent/catheter dysfunction (occlusion or migration of PS/NBC, development of cholangitis, or other conditions that required repeat endoscopic biliary intervention), and jaundice resolution (bilirubin level biliary drainage were also evaluated for association with the time to jaundice resolution and PS/NBC dysfunction using competing risk regression ***: In total, 419 patients were included in the study (PS, 253 and NBC, 166). Primary cancers included pancreatic cancer in 194 patients (46%), bile duct cancer in 172 (41%), gallbladder cancer in three (1%), and ampullary cancer in 50 (12%). The median serum total bilirubin was 7.8 mg/dL and 324 patients (77%) had ≥ 3.0 mg/dL. During the median time to surgery of 29 d [interquartile range (IQR), 30-39 d]. PS/NBC dysfunction rate was 35% for PS and 18% for NBC [Subdistribution hazard ratio (SHR) = 4.76; 95%CI: 2.44-10.0, P biliary drainage. Given the drawbacks of external drainage via NBC, an alternative method of internal drainage should be explored.

关键词： Endoscopic preoperative biliary drainage malignant distal biliary obstruction Periampullary cancer Plastic stent Nasobiliary drainage

Redefining endoluminal biliary drainage:Challenges and innovations in endosonography-guided techniques

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World Journal of Gastroenterology 2025年第1期31卷 146-151页

作者： Marcel Razpotnik Department of Gastroenterology and Hepatology Campus Virchow/Campus MitteCharitéBerlinBerlin 10117Germany

Endoscopic retrograde cholangiopancreatography is considered the gold standard for treating benign and malignant biliary ***,its use in complex biliary obstructions is *** the past decades,therapeutic endosonography(EUS)and emerging technologies such as lumen-apposing metal stents have enabled endoscopic treatment of conditions previously requiring nonendoscopic or surgical *** show that EUS-guided choledochoduodenostomy is a reliable alternative to endoscopic retrograde cholangiopancreatography in the treatment of distal malignant biliary obstructions and can be considered a primary drainage modality in centers with adequate *** malignant hilar biliary obstructions,draining at least 50%of viable liver tissue often requires combining different *** treatment strategy in these patients should be individualized,depending on the Bismuth classification,patient physical status,and intended systemic *** to the lack of evidence,general recommendations cannot be made for EUS-guided hepaticoduodenostomy or combined procedures with transhepatic bridging *** novel techniques should be limited to selected palliative cases where conventional methods have failed and conducted within clinical trials to generate evidence before broader application.

关键词： Endoscopic biliary drainage Interventional endosonography Lumen-apposing metal stent malignant hilar biliary obstruction malignant distal biliary obstruction

Folfirinox chemotherapy prolongs stent patency in patients with malignant biliary obstruction due to unresectable pancreatic cancer

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Hepatobiliary & Pancreatic Diseases International 2020年第6期19卷 590-595页

作者： Jinwoo Kang Sang Hyub Lee Jin Ho Choi Woo Hyun Paik Dong-Won Ahn Ji Bong Jeong Ji Kon Ryu Yong-Tae Kim Department of Internal Medicine and Liver Research Institute Seoul National University HospitalSeoul National University College of MedicineSeoulKorea Department of Internal Medicine SMG-SNU Boramae Medical CenterSeoulKorea

Background:Stent insertion for biliary decompression to relieve jaundice and subsequent biliary infection is necessary for patients with biliary obstruction caused by pancreatic cancer,and it is important to keep the stent patent as long as ***,few studies have compared stent patency in terms of chemotherapy in patients with pancreatic *** study aimed to evaluate the differences in stent patency in terms of recently evolving ***:Between January 2015 and May 2017,161 patients with pancreatic cancer who had undergone biliary stent insertion with a metal stent were retrospectively *** relationship between chemotherapy and stent patency was ***,overall survival according to the treatment,risk factors for stent patency,and long-term adverse events were ***:Median stent patency was 42 days for patients with the best supportive care and 217 days for patients with chemotherapy(conventional gemcitabine-based chemotherapy and folfirinox)(P<0.001).Furthermore,the folfirinox group showed the longest median stent patency and overall survival,with 283 days and 466 days,respectively(P<0.001)despite higher adverse events *** who underwent folfirinox chemotherapy after stent insertion had better stent patency in multivariate analysis(HR=0.26;95%CI:0.12–0.60;P=0.001).Conclusions:Compared with patients who received best supportive care only,patients who underwent chemotherapy after stent insertion had better stent *** prolonged stent patency can be expected for patients with folfirinox than conventional gemcitabine-based chemotherapy.

关键词： Stent patency malignant distal biliary obstruction Pancreatic cancer Folfirinox Chemotherapy