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Medline ® Abstract for Reference 36

of '恶性胰胆管梗阻的内镜下支架置入术'

36
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Comparison of the utility of covered metal stents versus uncovered metal stents in the management of malignant biliary strictures in 749 patients.
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Lee JH, Krishna SG, Singh A, Ladha HS, Slack RS, Ramireddy S, Raju GS, Davila M, Ross WA
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Gastrointest Endosc. 2013;78(2):312. Epub 2013 Apr 13.
 
BACKGROUND: Self-expandable metal stents (SEMSs) are used to relieve malignant biliary obstruction.
OBJECTIVE: To compare outcomes between covered self-expandable metal stents (CSEMSs) and uncovered self-expandable metal stents (USEMSs) in malignant biliary obstruction.
DESIGN: Retrospective cohort study.
SETTING: Tertiary cancer center.
PATIENTS: Patients with malignant biliary obstruction.
INTERVENTIONS: Placement of CSEMS or USEMS.
MAIN OUTCOME MEASUREMENTS: Time to recurrent biliary obstruction (TRO), overall survival (OS), and adverse events.
RESULTS: From January 2000 to June 2011, 749 patients received SEMSs: 171 CSEMSs and 578 USEMSs. At 1 year, there was no significant difference in the percentage of patients with recurrent obstruction (CSEMSs, 35% vs USEMSs, 38%) and survival (CSEMSs, 45% vs USEMSs, 49%). There was no significant difference in the median OS (CSEMSs, 10.4 months vs USEMSs, 11.8 months; P = .84) and the median TRO (CSEMSs, 15.4 months vs USEMSs, 26.3 months; P = .61). The adverse event rate was 27.5% for the CSEMS group and 27.7% for the USEMS group. Although tumor ingrowth with recurrent obstruction was more common in the USEMS group (76% vs 9%, P <.001), stent migration (36% vs 2%, P <.001) and acute pancreatitis (6% vs 1%, P <.001) were more common in the CSEMS group.
LIMITATIONS: Retrospective study.
CONCLUSIONS: There was no significant difference in the patency rate or overall survival between CSEMSs and USEMSs for malignant distal biliary strictures. The CSEMS group had a significantly higher rate of migration and pancreatitis than the USEMS group. No significant SEMS-related adverse events were observed in patients undergoing neoadjuvant chemoradiation or surgical resection.
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Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA. jefflee@mdanderson.org
PMID