Introduction
Materials and methods
Patients
Procedure
Outcomes and definitions
Statistical analysis
Results
Patient characteristics
Characteristics | N = 114 |
---|---|
Male, n (%) | 53 (46.5) |
Age, year, mean (SD) | 67.6 (12.4) |
Comorbidities | |
Metabolic disease, n (%) | 58 (50.9) |
Cardiac disease, n (%) | 39 (34.2) |
Liver disease, n (%) | 10 (8.8) |
Other, n (%) | 34 (29.8) |
Antiplatelets use, n (%) | 9 (7.9) |
Ursodeoxycholic acid use, n (%) | 20 (17.5) |
Perioperative bacterial infection or colonizationa, n (%) | 34 (29.8) |
With gallbladder, n (%) | 100 (87.7) |
Presence of gallstones, n (%) | 38 (33.3) |
Primary cancer | |
Pancreatic cancer, n (%) | 67 (58.8) |
Cholangiocarcinoma, n (%) | 10 (8.8) |
Other, n (%) | 37 (32.5) |
Stage, n (%) | |
I/II/III | 21 (18.4) |
IV | 93 (81.6) |
Primary tumor size, cm, median (IQR) | 3.9 (0.8, 13.2) |
Length of stricture, cm, mean (SD) | 3.9 (1.4) |
Part of obstruction | |
Proximal common bile duct, n (%) | 9 (7.9) |
Mid common bile duct, n (%) | 35 (30.7) |
Distal common bile duct, n (%) | 94 (82.5) |
More than one level of common bile duct obstruction, n (%) | 27 (23.7) |
Procedures and laboratory results | Value |
---|---|
Stent type | |
UC-SEMS, n (%) | 13 (11.4) |
PC-SEMS, n (%) | 88 (77.2) |
FC-SEMS, n (%) | 13 (11.4) |
Length of stent | |
6 cm, n (%) | 96 (84.2) |
8 cm, n (%) | 15 (13.2) |
10 cm, n (%) | 2 (1.8) |
12 cm, n (%) | 1 (0.9) |
Stent insertion with difficulty, n (%) | 10 (8.8) |
Percentage of diameter of stent after placement, compared with maximum diameter, median (IQR) | 51.1 (0.0, 79.9) |
Presence of stones or sludge during SEMS placement, n (%) | 23 (20.2) |
Total bilirubin before SEMS placement, mg/dL, median (IQR) | 8.3 (0.5, 32.5) |
Total bilirubin within 72 h after SEMS placement, mg/dL, median (IQR) | 3.9 (0.2, 24.2) |
Total bilirubin at 1 month after SEMS placement, mg/dL, median (IQR) | 1.6 (0.2, 29.3) |
Change of total bilirubin: within 72 h, mg/dL, median (IQR) | -3.4 (-17.7, 3.1) |
Change of total bilirubin at 1 month, mg/dL, median (IQR) | -6.0 (-31.4, 20.9) |
Concurrent tumor treatment, n (%) | 72 (63.2) |
Biliary SEMS dysfunction and associated risk factors
Factors | Patent SEMS | SEMS dysfunction | Univariate | Multivariate | ||
---|---|---|---|---|---|---|
n = 77 | n = 37 | HR(95% CI) | P-value | HR (95% CI) | P-value | |
Antiplatelets use | 5 | 4 | 1.53 (0.54, 4.34) | 0.426 | ||
Ursodeoxycholic acid use | 12 | 8 | 1.23 (0.56, 2.71) | 0.602 | ||
Primary cancer | ||||||
Cholangiocarcinoma | 5 | 5 | 2.2 (0.8, 5.9) | 0.117 | ||
Other | 26 | 11 | 0.8 (0.4, 1.6) | 0.485 | ||
Pancreatic cancer | 46 | 21 | 1 | |||
Size of cancer, median (IQR) | 3.8 (3.0, 4.8) | 4.0 (2.8, 5.1) | 1.3 (1.1, 1.5) | 0.006 | 1.20 (1.02, 1.40) | 0.025 |
Length of stricture, median (IQR) | 4.0 (3.0, 5.0) | 4.0 (2.5, 4.0) | 0.9 (0.7, 1.1) | 0.231 | ||
Current treatment (chemo/ RT/ surgery) | 45 | 27 | 1.4 (0.7, 3.1) | 0.336 | ||
Presence of stones or sludge during SEMS placement | 10 | 13 | 2.86 (1.43, 5.72) | 0.003 | 3.91 (1.74, 8.75) | 0.001 |
Total bilirubin at 1 month after SEMS placement, mg/dL, median (IQR) | 1.6 (0.2–23) | 1.8 (0.4, 29.3) | 1.12 (1.05, 1.19) | 0.001 | 1.14 (1.06, 1.22) | < 0.001 |
Length of stent | ||||||
10–12 | 1 | 1 | 1.35 (0.18, 10.02) | 0.767 | 2.10 (0.27, 16.12) | 0.476 |
8 | 9 | 6 | 2.57 (1.05, 6.28) | 0.039 | 2.96 (1.06, 8.30) | 0.039 |
6 | 67 | 30 | 1 | 1 | ||
Liver disease | 5 | 5 | 2.49 (0.96, 6.45) | 0.060 | ||
Perioperative bacterial infection | 21 | 12 | 1.43 (0.72, 2.88) | 0.310 | ||
Proximal common bile duct | 5 | 3 | 1.43 (0.43, 4.67) | 0.559 | ||
Distal common bile duct | 66 | 27 | 0.49 (0.24, 1.02) | 0.056 | ||
More than one level of common bile duct obstruction | 25 | 9 | 1.29 (0.61, 2.74) | 0.506 | ||
Stent type | ||||||
FC-SEMS | 8 | 5 | 0.54 (0.17, 1.71) | 0.295 | ||
PC-SEMS | 63 | 25 | 0.53 (0.23, 1.22) | 0.135 | ||
UC-SEMS | 6 | 7 | 1 | |||
Change of total bilirubin: within 72 h, mg/dL, median (IQR) | -6.1 (-17.7, 3.1) | -2.2 (-15.7, 3.1) | 1.04 (0.96, 1.12) | 0.315 | ||
Change of total bilirubin at 1 month, mg/dL, median (IQR) | -10.5 (-31.4, 6.5) | -4.0 (-27.8, 20.9) | 1.03 (0.98,1.07) | 0.249 | ||
Stent insertion with difficulty | 4 | 6 | 2.35 (0.98, 5.66) | 0.056 |
UC-SEMS | PC-SEMS | FC-SEMS | ||||
---|---|---|---|---|---|---|
n | days | n | days | n | days | |
Stone/ sludge | 1 | 85 | 13 | 97 (12–643) | 2 | 170.5 (147–194) |
Food particles | 3 | 157 (133–169) | 4 | 32 (12–245) | 1 | 93 |
Tumor ingrowth | 1 | 32 | 2 | 97 (97,97) | 1 | 207 |
Tumor overgrowth | 2 | 31.5 (13–50) |