Endoscopic bilio-duodenal bypass: outcomes of primary and revision efficacy of combined metallic stents in malignant duodenal and biliary obstructions
| Autor: | David Horta, João Coimbra, Mário J. Silva, António Mateus Dias, Diana Carvalho, Pedro Veiga, António Pereira Coutinho, Isabel Seves, Catarina A. B. Rodrigues, Mariana Costa, Jorge Canena, Leonel Ricardo, Carlos C. Romão, Gonçalo Ramos |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2014 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Duodenum Physiology medicine.medical_treatment Biliary Stenting Internal medicine medicine Humans Adverse effect Retrospective Studies Aged Aged 80 and over Colestase Cholestasis business.industry Hazard ratio Gastroenterology Stent Retrospective cohort study Middle Aged Hepatology equipment and supplies Surgery Major duodenal papilla Biliary Tract Surgical Procedures Treatment Outcome Duodenal obstruction Obstrução intestinal Concomitant Female Stents Duodenal Obstruction Radiology business |
| Zdroj: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) Agência para a Sociedade do Conhecimento (UMIC)-FCT-Sociedade da Informação instacron:RCAAP |
| Popis: | Self-expandable metal stents (SEMSs) can be used for palliation of combined malignant biliary and duodenal obstructions. However, the results of the concomitant stent placement for the duration of the patients’ lives, as well as the need for and efficacy of endoscopic revision, are unclear. This study evaluated the clinical effectiveness of SEMS placement for combined biliary and duodenal obstructions throughout the patients’ lives and the need for endoscopic revision. This study is a retrospective multicenter study of 50 consecutive patients who underwent simultaneous or sequential SEMS placement for malignant biliary and duodenal obstructions. The data were collected to analyze the sustained relief of obstructive symptoms until the patients’ death and the efficacy of endoscopic revision, as well as stent patency, adverse events, survival and prognostic factors for stent patency. Technical and immediate clinical success was achieved in all of the patients. Duodenal stricture occurred before the papilla in 35 patients (70 %), involved the papilla in 11 patients (22 %) and was observed distal to the papilla in four patients (8 %). Initial biliary stenting was performed endoscopically in 42 patients (84 %) and percutaneously in eight patients. After combined stenting, 30 patients (60 %) required no additional intervention until the time of their death. The remaining 20 patients were successfully treated using endoscopic stent reinsertion: nine patients needed biliary revision, three patients needed duodenal restenting and eight patients needed both biliary and duodenal reinsertion. The median duodenal stent patency and median biliary stent patency were 34 and 27 weeks, respectively. The median survival after combined stent placement was 18 weeks. A Cox multivariate analysis showed that duodenal stent obstruction after combined stenting was a risk factor for biliary stent obstruction (hazard ratio 6.85; 95 % confidence interval 1.43–198.98; P = 0.025). Endoscopic bilio-duodenal bypass is clinically effective, and the majority of the patients need no additional intervention until their death. Endoscopic revision is feasible and has a high success rate. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|