S0925 The Endoscopic Management of Stricture in Patients With Pancreaticoduodenectomy
Notice bibliographique
Résumé
INTRODUCTION: Stricture formation is a known post-pancreaticoduodenectomy (PD)-related adverse event (AE) and noted to be as high as 8.2% in the first 5 years. In this study, we assessed the safety and efficacy of ERCP for the treatment of choledochojejunostomy and pancreaticojejunostomy stricture. METHODS: We retrospectively evaluated patients with prior classic or pylorus-preserving PD who received ERCP from 01/13/06 to 01/16/19. ERCP reports were analyzed for stricture location, treatment for stricture, and stent characteristics. Outcomes included technical success rate—the ability to treat stricture with dilation or stent placement, and clinical success rate—a decrease in bilirubin to normal or 50% of peak value within 2 weeks. Statistical analysis was done using Stata/SE version 16.0. RESULTS: A total of 28 patients (75% male; median age 66 years, range 22–86 years) with prior PD received 66 ERCPs for biliary (25 patients received 63 ERCPs) and pancreatic (3 patients received 3 ERCPs) evaluation. All 3 ERCPs for pancreatic evaluation were unsuccessful. On hepatobiliary assessment, 16 patients had stricture on initial ERCP: choledochojejunostomy (n = 12), distal extrahepatic (n = 3) and hilar (n = 1). An additional 36 strictures were discovered on repeat ERCPs for a total of 52 strictures. Overall, the most common stricture location was at the choledochojejunostomy (n = 41), then the distal extrahepatic (n = 8), intrahepatic (n = 2), and hilar (n = 1). A total of 38 stents were placed: 33 plastic (86.8%), 3 uncovered metal (7.9%), and 2 covered metal (5.3%). More straight plastic stents (n = 23, 69.7%) were placed than double pigtail stents (n = 10, 30.3%), and the most common stent size was 10 Fr by 5 cm (n = 17, 44.7%). All strictures were treated with balloon dilation and subsequent stent placement when indicated. The technical success rate was 81.0% (51/63 ERCPs) and the clinical success rate was 76.2% (48/63 ERCPs). Procedure-related AEs occurred in 5/66 ERCPs (7.6%): 4 cases of self-resolving fever, 1 case of mild cholangitis. CONCLUSION: ERCP is a safe and effective modality for the management of post-PD-related stricture. The incidence of stricture formation was likely inflated in our population given the nature of a large tertiary cancer-center. Further technological advancements and improvements in technique are required for pancreatic intervention in post-PD patients.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».