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©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 7, 2018; 24(1): 69-75
Published online Jan 7, 2018. doi: 10.3748/wjg.v24.i1.69
Safety and efficacy of metallic stent for unresectable distal malignant biliary obstruction in elderly patients
Yuji Sakai, Tomohisa Iwai, Kenji Shimura, Katsushige Gon, Kazuya Koizumi, Masashi Ijima, Kazuro Chiba, Seigo Nakatani, Harutoshi Sugiyama, Toshio Tsuyuguchi, Terumi Kamisawa, Iruru Maetani, Mitsuhiro Kida
Yuji Sakai, Harutoshi Sugiyama, Toshio Tsuyuguchi, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
Tomohisa Iwai, Seigo Nakatani, Mitsuhiro Kida, Department of Gastroenterology, Kitasato University School of Medicine, Kanagawa 252-0375, Japan
Kenji Shimura, Department of Gastroenterology, Asahi Central Hospital, Chiba 289-2511, Japan
Katsushige Gon, Iruru Maetani, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Ohashi Medical Center, Tokyo 153-8515, Japan
Kazuya Koizumi, Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
Masashi Ijima, Department of Gastroenterology, Subaru Health Insurance Society Ota Memorial Hospital, Gunma 373-8585, Japan
Kazuro Chiba, Terumi Kamisawa, Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo 113-8677, Japan
Author contributions: Sakai Y, Sugiyama H and Tsuyuguchi T were responsible for the study design, data analysis, and manuscript preparation; Sakai Y wrote the paper; Sakai Y, Shimura K, Koizumi K, Ijima M, Chiba K, Tsuyuguchi T, Kamisawa T, Maetani I and Kida M performed endoscopic treatment; Iwai T, Gon K, Nakatani S and Sugiyama H were responsible for data collection.
Institutional review board statement: This study was conducted under approval our ethical committee.
Informed consent statement: All the treatment procedures were performed after obtaining the informed consent in writing from the patients.
Conflict-of-interest statement: The authors have no other disclosures.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yuji Sakai, MD, PhD, Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuou-ku, Chiba 260-8670, Japan.
sakai4754@yahoo.co.jp
Telephone: +81-43-2262083 Fax: +81-43-2262088
Received: October 29, 2017
Peer-review started: October 30, 2017
First decision: November 21, 2017
Revised: December 2, 2017
Accepted: December 12, 2017
Article in press: December 12, 2017
Published online: January 7, 2018
Processing time: 69 Days and 6 Hours
ARTICLE HIGHLIGHTS
Research background
The related procedure of endoscopic retrograde cholangiopancreatography (ERCP) is a minimally invasive diagnostic and therapeutic method for biliary and pancreatic diseases and plays a very important role. As for biliary drainage, endoscopic drainage by ERCP is considered to be noninvasive and the first choice of treatment.
Research motivation
To our knowledge, there are no reports that examined the safety of insertion of metallic stents in the elderly with an unresectable malignant biliary obstruction. Therefore, we studied the safety and usefulness of metallic stents for unresectable distal malignant biliary obstruction in a multicenter, collaborative, retrospective study.
Research objectives
This study aims to evaluate the safety of insertion of metallic stents in elderly patients with unresectable distal malignant biliary obstruction.
Research methods
There are total 272 patients with unresectable distal malignant biliary obstruction in this study. Group A (184 patients under the age of 80) and Group B (88 subjects aged 80 years or more) were examined by the safety of metallic stent insertion, metal stent patency period, and the obstruction rate.
Research results
In Group B, patients had a significantly worse performance status, high blood pressure, cerebrovascular disease, heart disease, and dementia; besides the rate of patients orally administered antiplatelet drugs or anticoagulants tended to be higher (P < 0.05). Metallic stents were successfully inserted in all patients. The median patency period was 265.000 ± 26.779 d (1-965); 252.000 ± 35.998 d (1-618) in Group A and 269.000 ± 47.885 d (1-965) in Group B, with no significant difference between the two groups. Metallic stent obstruction occurred in 30.15% (82/272) patients; in 28.80% (53/184) patients in Group A and in 32.95% (29/88) of those in Group B, showing no significant difference between the two groups.
Research conclusions
This study suggested that metallic stents can be safely inserted and are a useful treatment for unresectable distal malignant biliary obstruction in the elderly. It was suggested that metallic stent insertion for unresectable distal malignant biliary obstruction in the elderly can be conducted safely and with a high success rate. We should insert metallic stent in unresectable distal malignant biliary obstruction in the elderly patients for improvement of quality of life positively.
Research perspectives
A prospective study is considered necessary in the future to further evaluate the feasibility and usefulness of metallic stent for unresectable distal malignant biliary obstruction in elderly patients.
