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Abstract
Background/Aims
Metal stent insertion through percutaneous transhepatic biliary drainage (PTBD) track is an important palliative treatment modality for malignant biliary obstruction. Acute pancreatitis is one of serious complications of biliary metal stenting. The purpose of this study was to investigate the risk of pancreatitis for patients who underwent metal stent insertion via PTBD track.
Methods
A retrospective analysis of 90 consecutive patients who received metal stent insertion via PTBD track from Jan. 2002 to Dec. 2007 was carried out. Patients were devided into the transpapillary and non-transpapillary group, and the risks of pancreatitis were compared. The effects of preliminary endoscopic sphincterectomy (EST) was also investigated in transpapillary group.
Results
The rate of pancreatitis was higher in transpapillary group compared to nontranspapillary group (odd ratio 1.87, 95% CI 0.516-6.761), but it showed no stastically significance (p=0.502). In transpapillary group, patients who received preliminary EST showed lower rate of pancreatitis (odd ratio 0.91, 95% CI 0.656-1.273), but it showed no stastically significance (p=0.614).
REFERENCES
1. Andersen JR, Sorensen SM, Kruse A, Rokkjaer M, Matzen P. Randomised trial of endoprothesis versus operative bypass in malignant obstructive jaundice. Gut. 1989; 30:1132–1135.
2. Luman W, Cull A, Palmer KR. Quality of life in patients stented for malignant biliary obstructions. Eur J Gastroenterol Hepatol. 1997; 9:481–484.
3. Hoepffner N, Foerster EC, Hogemann B, Domschke W. Long term experience in wallstent therapy for malignant choledochal stenosis. Endoscopy. 1994; 26:597–602.
4. Knyrim K, Wabner HJ, Pausch J, Vakil N. A prospective randomized controlled trial of metal stents for malignant obstruction of the common bile duct. Endoscopy. 1993; 25:207–212.
5. David PH, Groen AK, Rauws EA, Huibregtse K. Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet. 1992; 340:1488–1492.
6. Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991; 37:383–393.
7. Inal M, Akgul E, Aksungur E, Yagmur O. Percutaneous self-expandable uncovered metallic stents in malignant biliary obstruction. Complications, follow-up and reintervention in 154 patients. Acta Radiol. 2003; 44:139–146.
8. Testoni PA, Bagnolo F, Caporuscino S, Lella F. Serum amylase measured four hours after endoscopic sphincterotomy is a reliable predictor of postprocedure pancreatitis. Am J Gastroenterol. 1999; 94:1234–1241.
9. Wig JD, Kumar H, Suri S, Gupta NM. Usefulness of percutaneous transhepatic biliary drainage in patients with surgical jaundice - a prospective randomized study. J Ass Phy Ind. 1999; 47:271–274.
10. Luska G, Poser H. Acute pancreatitis in obstructive jaundice following combined internal and external percutaneous transhepatic bile duct drainage (PTBD). Eur J Radiol. 1983; 3:112–114.
11. Joseph PK, Bizer LS, Sprayregen S, Gliedman ML. Percutaneous transhepatic biliary drainage. Results and complications in 81 patients. JAMA. 1986; 255:2763–2767.
12. Al-Bahrani AZ, Holt A, Hamade AM, et al. Acute pancreatitis: an under-recognized risk of percutaneous transhepatic distal biliary intervention. HPB (Oxford). 2006; 8:446–450.
Table 1.
Patient Characteristics
Table 2.
Frequency of Pancreatitis and Changes of Amylase
Table 3.
Changes of Amylase in Transpapillary Group according to Preliminary EST
Table 4.
Patient Characteristics in Pancreatitis (n=10)
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