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A non-randomized study in consecutive patients with postcholecystectomy refractory biliary leaks who were managed endoscopically with the use of multiple plastic stents or fully covered self-expandable metal stents (with videos).
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Orientador(es)
Resumo(s)
BACKGROUND:
Endoscopic management of postcholecystectomy biliary leaks is widely accepted as the treatment of choice. However, refractory biliary leaks after a combination of biliary sphincterotomy and the placement of a large-bore (10F) plastic stent can occur, and the optimal rescue endotherapy for this situation is unclear.
OBJECTIVE:
To compare the clinical effectiveness of the use of a fully covered self-expandable metal stent (FCSEMS) with the placement of multiple plastic stents (MPS) for the treatment of postcholecystectomy refractory biliary leaks.
DESIGN:
Prospective study.
SETTING:
Two tertiary-care referral academic centers and one general district hospital.
PATIENTS:
Forty consecutive patients with refractory biliary leaks who underwent endoscopic management.
INTERVENTIONS:
Temporary placement of MPS (n = 20) or FCSEMSs (n = 20).
MAIN OUTCOME MEASUREMENTS:
Clinical outcomes of endotherapy as well as the technical success, adverse events, need for reinterventions, and prognostic factors for clinical success.
RESULTS:
Endotherapy was possible in all patients. After endotherapy, closure of the leak was accomplished in 13 patients (65%) who received MPS and in 20 patients (100%) who received FCSEMSs (P = .004). The Kaplan-Meier (log-rank) leak-free survival analysis showed a statistically significant difference between the 2 patient populations (χ2 [1] = 8.30; P < .01) in favor of the FCSEMS group. Use of <3 plastic stents (P = .024), a plastic stent diameter <20F (P = .006), and a high-grade biliary leak (P = .015) were shown to be significant predictors of treatment failure with MPS. The 7 patients in whom placement of MPS failed were retreated with FCSEMSs, resulting in closure of the leaks in all cases.
LIMITATIONS:
Non-randomized design.
CONCLUSION:
In our series, the results of the temporary placement of FCSEMSs for postcholecystectomy refractory biliary leaks were superior to those from the use of MPS. A randomized study is needed to confirm our results before further recommendations.
Descrição
Palavras-chave
Endoscopia Gastrointestinal Stents Procedimentos Cirúrgicos do Sistema Biliar Biliary Tract Surgical Procedures Endoscopy, Gastrointestinal
Contexto Educativo
Citação
Gastrointest Endosc. 2015 Mar 11. pii: S0016-5107(14)02490-0.