Potential significance of uncovered self‐expandable metal stents for distal malignant biliary obstruction: A propensity score‐adjusted competing risk regression analysis
Yuichi Torisu,
Masafumi Chiba,
Masayuki Kato,
Yuji Kinoshita,
Takafumi Akasu,
Tomoya Kanai,
Yoichi Tomita,
Nana Shimamoto,
Takahiro Abe,
Keisuke Kanazawa,
Shintaro Tsukinaga,
Masanori Nakano,
Chisato Saeki,
Kazuki Sumiyama,
Masayuki Saruta
Affiliations
Yuichi Torisu
Department of Internal Medicine Division of Gastroenterology and Hepatology, The Jikei University School of Medicine Tokyo Japan
Masafumi Chiba
Department of Endoscopy The Jikei University School of Medicine Tokyo Japan
Masayuki Kato
Department of Endoscopy The Jikei University School of Medicine Tokyo Japan
Yuji Kinoshita
Department of Internal Medicine Division of Gastroenterology and Hepatology, The Jikei University School of Medicine Tokyo Japan
Takafumi Akasu
Department of Internal Medicine Division of Gastroenterology and Hepatology, The Jikei University School of Medicine Tokyo Japan
Tomoya Kanai
Department of Internal Medicine Division of Gastroenterology, Fuji City General Hospital Shizuoka Japan
Yoichi Tomita
Department of Internal Medicine Division of Gastroenterology and Hepatology, The Jikei University School of Medicine Tokyo Japan
Nana Shimamoto
Department of Endoscopy The Jikei University School of Medicine Tokyo Japan
Takahiro Abe
Department of Endoscopy The Jikei University School of Medicine Tokyo Japan
Keisuke Kanazawa
Department of Endoscopy The Jikei University School of Medicine Tokyo Japan
Shintaro Tsukinaga
Department of Endoscopy The Jikei University School of Medicine Tokyo Japan
Masanori Nakano
Department of Internal Medicine Division of Gastroenterology and Hepatology, The Jikei University School of Medicine Tokyo Japan
Chisato Saeki
Department of Internal Medicine Division of Gastroenterology and Hepatology, The Jikei University School of Medicine Tokyo Japan
Kazuki Sumiyama
Department of Endoscopy The Jikei University School of Medicine Tokyo Japan
Masayuki Saruta
Department of Internal Medicine Division of Gastroenterology and Hepatology, The Jikei University School of Medicine Tokyo Japan
Abstract Objectives Selection criteria for self‐expandable metal stents (SEMSs) with or without cover during palliative treatment of distal malignant biliary obstruction (DMBO) remain unclear. We evaluated factors associated with time to recurrent biliary obstruction (TRBO) in fully covered SEMSs (FCSEMSs) and uncovered SEMSs (UCSEMSs). Methods We retrospectively analyzed consecutive patients with DMBO who received a SEMS. TRBO was determined using the Kaplan–Meier analysis, and complications were compared between the FCSEMS and UCSEMS groups. After TRBO‐associated factors were extracted using multivariate competing‐risks regression (CRR), propensity score‐adjusted CRRs were performed to verify their robustness. Results There were 180 patients (66 FCSEMSs and 114 UCSEMSs) enrolled in this study. There was no significant difference between median TRBO in the FCSEMS and UCSEMS groups (275 vs. 255 days, p = 0.67). Complications were more frequent in the FCSEMS than UCSEMS group (21.2% vs. 8.8%; p = 0.023). Multivariate CRR for TRBO‐associated factors revealed that “pancreatic ductal carcinoma (PDAC) treated with UCSEMS” was the only independent predictor of TRBO (p = 0.03). Similarly, the propensity score‐adjusted CRRs showed no significant difference in TRBO in “FCSEMS” vs “UCSEMS” (p = 0.96); however, there was a significant difference in “PDAC using UCSEMS” vs “other” (p = 0.043). In the palliative care group including any DMBO without chemotherapy, the first quartile of the TRBO of UCSEMS was 100 days. Conclusions UCSEMSs are a possible option for both patients with DMBO arising from PDAC and for patients with any DMBO receiving palliative care who should avoid SEMS‐related complications.
