초록 열기/닫기 버튼
Background/Aims: Many unanswered questions remain about the treatment of malignant hilar obstruction. We investigatedendoscopic stenting for malignant biliary strictures, as reported in a nationwide registry. Methods: All endoscopic retrograde cholangiopancreatography (ERCP) procedures entered in the Swedish Registry of GallstoneSurgery and ERCP from January 2010 to December 2017 in which stenting was performed for malignant biliary stricturemanagement were included in this study. Patency was estimated by determining the time to reintervention. Results: Endoscopic stenting was performed for malignant stricture management in 4623 ERCP procedures, of which 1364(29.5%) were performed for hilar strictures. Of the hilar strictures, 320 (23.5%) were intrahepatic strictures (Bismuth–Corlette III–IV). Adverse events were more common after hilar stenting than after distal stenting (17.2% vs. 12.0%, p<0.0001). The 6-monthreintervention rate was 73.4% after hilar stenting compared with 55.9% after distal stenting (p<0.0001). The 6-month reinterventionrates for Bismuth–Corlette types I, II, IIIa, IIIb, and IV were 70.4%, 75.6%, 90.0%, 87.5%, and 85.7%, respectively. In multivariateanalysis, the risk for reintervention was three times higher after hilar stenting than after distal stenting (hazard ratio 3.47, 95%confidence interval 2.01–6.00, p<0.001). Conclusions: This study with a relatively large patient cohort undergoing endoscopic stenting confirms that stenting for malignant hilarobstruction has more adverse events and lower patency than stenting for distal malignant obstruction.
