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One- and two-step self-expandable metal stent placement for distal malignant biliary obstruction: a propensity analysis

Authors
  • Hamada, Tsuyoshi1, 2
  • Nakai, Yousuke1
  • Isayama, Hiroyuki1
  • Togawa, Osamu3
  • Kogure, Hirofumi1
  • Kawakubo, Kazumichi1
  • Tsujino, Takeshi2
  • Sasahira, Naoki1
  • Hirano, Kenji1
  • Yamamoto, Natsuyo1
  • Ito, Yukiko2
  • Sasaki, Takashi1
  • Mizuno, Suguru4
  • Toda, Nobuo5
  • Tada, Minoru1
  • Koike, Kazuhiko1
  • 1 Graduate School of Medicine, The University of Tokyo, Department of Gastroenterology, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan , Tokyo (Japan)
  • 2 Japanese Red Cross Medical Center, Department of Gastroenterology, Tokyo, Japan , Tokyo (Japan)
  • 3 JR Tokyo General Hospital, Department of Gastroenterology, Tokyo, Japan , Tokyo (Japan)
  • 4 Kanto Central Hospital, Department of Gastroenterology, Tokyo, Japan , Tokyo (Japan)
  • 5 Mitsui Memorial Hospital, Department of Gastroenterology, Tokyo, Japan , Tokyo (Japan)
Type
Published Article
Journal
Journal of Gastroenterology
Publisher
Springer Japan
Publication Date
Apr 20, 2012
Volume
47
Issue
11
Pages
1248–1256
Identifiers
DOI: 10.1007/s00535-012-0582-3
Source
Springer Nature
Keywords
License
Yellow

Abstract

BackgroundAlthough self-expandable metal stents (SEMS) are widely used for distal malignant biliary obstruction, one-step SEMS (direct placement without a prior plastic stent) and two-step SEMS (placement at second endoscopic retrograde cholangiopancreatography [ERCP] following plastic stent placement) have not been fully compared.MethodsIn this multicenter retrospective study, patients were included who underwent first-time endoscopic SEMS placement between September 1994 and December 2010. We compared the one-step and two-step strategies using a propensity analysis.ResultsIn total, 370 patients were identified and one-step SEMS was performed in 59 patients. After adjustment using propensity scores, the median times to dysfunction were 116 and 219 days, respectively, for one-step and two-step SEMS (P = 0.058). Stent migration was more frequently observed in one-step SEMS as compared with two-step SEMS (25 vs. 11 %, P = 0.031). In one-step SEMS, the number of days of hospitalization associated with first-time SEMS placement was shorter compared with that in two-step SEMS (21 vs. 30 days, P = 0.001), and the total costs of SEMS-related interventions within 6 months were lower (6510 and 8100 USD, P = 0.004). The pathological diagnosis rates for pancreatic and biliary tract cancer at initial ERCP were 52 and 61 %. After failed diagnosis at initial ERCP, pathological diagnosis rates for pancreatic cancer were 32 versus 76 % (P = 0.005) by repeated ERCP versus endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA).ConclusionsOne-step SEMS was associated with increased stent migration, despite having potential cost-effectiveness. The additional yield of pathological diagnosis at repeated ERCP was low compared with that yielded by EUS-guided FNA.

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