针对远端恶性胆道阻塞 (SPHINX) 的自我扩展金属支架放置后,用于预防ERCP后胰腺炎的内镜缩切术:一个多中心,随机对照试验
Anke M Onnekink1, Myrte Gorris2, Noor Lh Bekkali3
1Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands a.m.onnekink@lumc.nl.
Gut
|October 10, 2024
概括
在接受胆道支架置于恶性胆道阻塞的患者中,内镜缩膜切除并没有降低ERCP后胰腺炎 (PEP) 的风险. 在完全覆盖的自扩展金属支架放置之前,不建议进行例行透切除术.
科学领域:
- 胃肠病学 胃肠病学
- 干预性内镜检查是干预性的内镜检查.
- 胆汁干预 胆汁干预
背景情况:
- 内镜逆行胆血管细胞造影 (ERCP) 与完全覆盖的自扩展金属支架 (FCSEMS) 放置是远端恶性胆道阻塞 (MBO) 的标准.
- 在FCSEMS安置后,存在严重的ERCP后胰腺炎 (PEP) 风险.
- 建议进行内镜透切除,以减轻PEP风险.
研究的目的:
- 为了评估内镜膜切除术在预防PEP方面的疗效.
- 为了比较接受FCSEMS安置的患者与没有先前的膜切除术之间的PEP率.
主要方法:
- 一个多中心的,随机的,优越性试验,涉及疑似远端MBO的患者.
- 在FCSEMS安置之前,患者被随机分为接受内镜缩切除术或不进行缩切除术.
- 主要结局是30天内PEP;次要结局包括其他并发症和死亡率.
主要成果:
- 在招募297名患者后,试验由于徒劳而提前终止.
- 在截切除组 (17%) 和对照组 (21%),PEP率相似,没有统计学上显著的差异 (p=0.37).
- 两组之间在出血,穿孔,胆管炎,胆囊炎或30天死亡率方面没有发现显著差异.
结论:
- 在FCSEMS放置远端MBO后减少PEP方面,内镜缩术并不优于没有缩术.
- 目前的证据不支持在这个患者群体中在FCSEMS安置之前进行内镜截切除术的常规使用.
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