Placement of biliary self-expandable metal stents after metal stenting in duodenum / 中华消化内镜杂志

ABSTRACT

Objective To explore the success rate and failure risk factors of biliary stenting on the patients with type Ⅰor Ⅱ duodenal malignant stricture treated by self-expandable metallic stent (SEMS). Methods A total of 36 patients with unresectable duodenal stricture after endoscopic SEMS placement be-tween February 2010 and February 2014 at Xijing Digestive Disease Hospital were enrolled.These patients underwent ERCP biliary metal stenting subsequently due to the malignant biliary stenosis.The clinical and imaging features of these patients were retrospectively analyzed.Results ERCP biliary stenting was suc-cessfully completed in 66.7% of patients with previous duodenal SEMS treatment.The success rates of pa-tients with type Ⅰ and Ⅱ duodenal stricture were 88.0% and 18.2% respectively(P <0.001).The suc-cess rates of patients with different lengths of duodenal stenosis were 88.9% for <3.5 cm and 44.4% for ≥3.5 cm (P =0.005).Compared with 80 or 90 mm duodenal stent,patients with 60 mm stent had a higher completion rate for ERCP biliary stent (88.0% VS 18.2%,P <0.001).Multivariate logistic regression a-nalysis revealed that length of duodenal stenosis ≥3.5 cm and 80 or 90 mm duodenal stent were independent factors for failure of ERCP in patients with previous SEMS placement.Conclusion For unresectable DMS patients with SEMS placement,subsequently ERCP biliary metal stenting is safe and effective.The length of duodenal malignant stenosis and longer duodenal stent are high-risk factors for the failure of ERCP biliary stenting.