Risk factors for recurrent biliary obstruction following endoscopic biliary stenting in patients with unresectable ampullary cancer: A multicenter retrospective study

Ryo Sugiura; Masaki Kuwatani; Toshifumi Kin; Ryusuke Matsumoto; Yuki Ikeda; Itsuki Sano; Koji Hirata; Makoto Yoshida; Yoshiharu Masaki; Michihiro Ono; Hajime Hirata; Hiroaki Yamato; Manabu Onodera; Hideaki Nakamura; Yoko Taya; Nobuyuki Ehira; Masahito Nakajima; Hidemasa Kawabata; Hideyuki Ihara; Taiki Kudo; Shin Kato; Akio Katanuma

doi:10.1111/1751-2980.13288

Journal of Digestive Diseases ›› 2024, Vol. 25 ›› Issue (5) : 310 -317. DOI: 10.1111/1751-2980.13288

ORIGINAL ARTICLE

Risk factors for recurrent biliary obstruction following endoscopic biliary stenting in patients with unresectable ampullary cancer: A multicenter retrospective study

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¹. Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan

². Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Hokkaido, Japan

³. Department of Gastroenterology, Obihiro Kosei Hospital, Obihiro, Hokkaido, Japan

⁴. Department of Gastroenterology, Oji General Hospital, Tomakomai, Hokkaido, Japan

⁵. Department of Internal Medicine, Kushiro Rosai Hospital, Kushiro, Hokkaido, Japan

⁶. Department of Gastroenterology and Hepatology, Hakodate Municipal Hospital, Hakodate, Hokkaido, Japan

⁷. Department of Medical Oncology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan

⁸. Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan

⁹. Department of Gastroenterology, Steel Memorial Muroran Hospital, Muroran, Hokkaido, Japan

¹⁰. Department of Gastroenterology, Tomakomai City Hospital, Tomakomai, Hokkaido, Japan

¹¹. Department of Gastroenterology, Iwamizawa Municipal General Hospital, Iwamizawa, Hokkaido, Japan

¹². Department of Gastroenterology, NTT East Sapporo Hospital, Sapporo, Hokkaido, Japan

¹³. Department of Gastroenterology, Hokkaido Gastroenterology Hospital, Sapporo, Hokkaido, Japan

¹⁴. Department of Gastroenterology, Hokkaido Medical Center, Sapporo, Hokkaido, Japan

¹⁵. Department of Gastroenterology, Kitami Red Cross Hospital, Kitami, Hokkaido, Japan

¹⁶. Department of Gastroenterology, Aiiku Hospital, Sapporo, Hokkaido, Japan

¹⁷. Department of Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan

¹⁸. Department of Gastroenterology, Tonan Hospital, Sapporo, Hokkaido, Japan

¹⁹. Department of Gastroenterology, IMS Sapporo Digestive Disease Center General Hospital, Sapporo, Hokkaido, Japan

²⁰. Department of Gastroenterology, Sapporo City General Hospital, Sapporo, Hokkaido, Japan

mkuwatan@med.hokudai.ac.jp

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Abstract

Objectives: Unresectable ampullary cancer (AC) is a rare disease entity. The risk factors for recurrent biliary obstruction (RBO) following endoscopic biliary stenting (EBS) for unresectable AC remain unknown. In this study we aimed to evaluate the cumulative RBO rate and to identify risk factors for RBO following palliative EBS in patients with unresectable AC.

Methods: This multicenter retrospective observational study enrolled consecutive patients with unresectable AC who had undergone palliative EBS between April 2011 and December 2021. The cumulative rate of and risk factors for RBO following palliative EBS were evaluated via multivariate analysis.

Results: The study analysis comprised 107 patients with a median age of 84 years (interquartile range 79–88 years). Plastic stents (PSs) and self-expandable metal stents (SEMSs) were placed in 53 and 54 patients, respectively. Functional success was accomplished in 104 (97.2%) patients. Of these, RBO occurred in 62 (59.6%) patients, with obstruction and complete/partial migration occurring in 47 and 15 patients, respectively. The median time to RBO was 190 days. Multivariate analysis showed that PS was associated with a higher rate of RBO compared to SEMS (hazard ratio [HR] 2.48; P < 0.01) and that the presence of common bile duct stones/sludge immediately after EBS was an independent risk factor for RBO (HR 1.99; P = 0.04).

Conclusions: The use of SEMS compared to PS during EBS reduced the time to RBO in patients with unresectable AC. Common bile duct stones/sludge immediately after EBS was a risk factor for RBO.

Keywords

ampullary cancer / endoscopic biliary stenting / plastic stent / recurrent biliary obstruction / self expandable metallic sten

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Ryo Sugiura, Masaki Kuwatani, Toshifumi Kin, Ryusuke Matsumoto, Yuki Ikeda, Itsuki Sano, Koji Hirata, Makoto Yoshida, Yoshiharu Masaki, Michihiro Ono, Hajime Hirata, Hiroaki Yamato, Manabu Onodera, Hideaki Nakamura, Yoko Taya, Nobuyuki Ehira, Masahito Nakajima, Hidemasa Kawabata, Hideyuki Ihara, Taiki Kudo, Shin Kato, Akio Katanuma. Risk factors for recurrent biliary obstruction following endoscopic biliary stenting in patients with unresectable ampullary cancer: A multicenter retrospective study. Journal of Digestive Diseases, 2024, 25(5): 310-317 DOI:10.1111/1751-2980.13288

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2024 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.