Bridging across the ampulla of Vater with covered self-expanding metallic stents: is it contraindicated when treating malignant gastroduodenal obstruction?

摘要

PURPOSE: To determine if concern for biliary obstruction constitutes a contraindication to the placement of a covered self-expandable metallic stent (SEMS) bridging the ampulla of Vater (AOV). MATERIALS AND METHODS: Retrospective review of fluoroscopic images of stent placement was performed in 62 patients (43 men; mean age, 62 years) with malignant gastroduodenal obstruction treated with a partially covered SEMS. Bare (n = 35) and covered (n = 27) stent portions were placed to bridge the AOV. Preprocedural and postprocedural bilirubin and alkaline phosphatase (ALP) levels were reviewed. The incidence of external biliary drainage tube insertion within 1 month was compared between groups. In 27 patients with postprocedural computed tomography studies, causes of bile duct dilation were evaluated. RESULTS: Compared to preprocedural data, postprocedural bilirubin and ALP levels were elevated significantly in both groups (bilirubin, mg/dL, 1.8 +/- 2.3 vs 2.8 +/- 3.7, P = .02 for bare, 1.6 +/- 1.7 vs 3.6 +/-4.4, P = .02 for covered; ALP, IU/L, 193.2 +/- 174.8 vs 292.9 +/- 293.7, P = .01 for bare, 214.7 +/- 213.3 vs 357.6 +/- 234.4, P < .01 for covered group). Changes in laboratory measurements were not significantly different between groups (bilirubin, 1.1 mg/dL +/- 2.2 and 2.2 mg/dL +/- 4.0 in bare and covered groups, respectively [P = .19]; ALP, 128.9 IU/L +/- 207.0 and 156.3 IU/L +/- 136.1, respectively [P = .56]). The incidence of external biliary drainage tube insertion was not significantly different between groups (17.1% and 25.9% in bare and covered stent groups, P = .53). The stent was the cause of bile duct dilation in only one patient. CONCLUSIONS: It is suggested that it is not contraindicated to place a covered SEMS to bridge the AOV.