PMID- 36328210
OWN - NLM
STAT- MEDLINE
DCOM- 20230327
LR  - 20230523
IS  - 1097-6779 (Electronic)
IS  - 0016-5107 (Linking)
VI  - 97
IP  - 4
DP  - 2023 Apr
TI  - Effect of ursodeoxycholic acid after self-expandable metal stent placement in 
      malignant distal biliary obstruction: a propensity score-matched cohort analysis.
PG  - 713-721.e6
LID - S0016-5107(22)02130-7 [pii]
LID - 10.1016/j.gie.2022.10.038 [doi]
AB  - BACKGROUND AND AIMS: Sludge occlusion is a primary reason for recurrent biliary 
      obstruction (RBO) after self-expandable metallic stent (SEMS) placement. However, 
      the efficacy of ursodeoxycholic acid (UDCA) for SEMS occlusion remains unexplored 
      to date. This study aimed to evaluate the efficacy of UDCA after SEMS placement 
      for malignant distal biliary obstruction (MDBO). METHODS: Three hundred 
      fifty-four patients were included, of which 60 received UDCA. Additionally, we 
      conducted a propensity score-matched cohort analysis on 110 patients with SEMS 
      placement for MDBO to reduce selection bias. Patients were categorized into 2 
      groups of 55 each, based on whether they received UDCA. In the UDCA group, the 
      treatment was administered for more than a month. The primary endpoint was the 
      time to RBO (TRBO) after SEMS placement. The secondary endpoint was to evaluate 
      SEMS occlusion rate and early adverse events (AEs). RESULTS: The cumulative SEMS 
      occlusion rate was 41.8% and 18.2% in the groups with and without UDCA, 
      respectively (P = .0119). Median TRBO was significantly longer in the control 
      group than in the UDCA group (528 vs 154 days, P = .0381). In the multivariate 
      analysis, UDCA administration was identified as the independent risk factor for 
      reducing TRBO (hazard ratio, 2.28; 95% confidence interval, 1.06-4.88; P = 
      .0348). The overall early AE rate showed insignificant differences between 
      groups. CONCLUSIONS: Administering UDCA after SEMS placement was not efficacious 
      for prolonging the TRBO in MDBO. Moreover, administering UDCA beyond a month 
      might increase the risk of stent sludge occlusion. (Clinical trial registration 
      number: UMIN000046862.).
CI  - Copyright (c) 2023 American Society for Gastrointestinal Endoscopy. Published by 
      Elsevier Inc. All rights reserved.
FAU - Okuno, Mitsuru
AU  - Okuno M
AD  - Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan.
FAU - Iwata, Keisuke
AU  - Iwata K
AD  - Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan.
FAU - Mukai, Tsuyoshi
AU  - Mukai T
AD  - Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan; Department 
      of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan.
FAU - Ohashi, Yosuke
AU  - Ohashi Y
AD  - Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan.
FAU - Iwata, Shota
AU  - Iwata S
AD  - Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan.
FAU - Iwasa, Yuhei
AU  - Iwasa Y
AD  - Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan.
FAU - Yoshida, Kensaku
AU  - Yoshida K
AD  - Department of Gastroenterology, Gifu Prefecture General Medical Center, Gifu, 
      Japan.
FAU - Maruta, Akinori
AU  - Maruta A
AD  - Department of Gastroenterology, Gifu Prefecture General Medical Center, Gifu, 
      Japan.
FAU - Tezuka, Ryuichi
AU  - Tezuka R
AD  - First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
FAU - Ichikawa, Hironao
AU  - Ichikawa H
AD  - First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
FAU - Mita, Naoki
AU  - Mita N
AD  - First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
FAU - Uemura, Shinya
AU  - Uemura S
AD  - First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
FAU - Iwashita, Takuji
AU  - Iwashita T
AD  - First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
FAU - Tomita, Eiichi
AU  - Tomita E
AD  - Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan.
FAU - Shimizu, Masahito
AU  - Shimizu M
AD  - First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
LA  - eng
PT  - Journal Article
DEP - 20221101
PL  - United States
TA  - Gastrointest Endosc
JT  - Gastrointestinal endoscopy
JID - 0010505
RN  - 724L30Y2QR (Ursodeoxycholic Acid)
RN  - 0 (Sewage)
SB  - IM
CIN - Gastrointest Endosc. 2023 May;97(5):994. PMID: 37076200
MH  - Humans
MH  - Ursodeoxycholic Acid/therapeutic use
MH  - Propensity Score
MH  - Sewage
MH  - *Self Expandable Metallic Stents/adverse effects
MH  - Cohort Studies
MH  - *Cholestasis/etiology/therapy
MH  - Stents/adverse effects
MH  - Retrospective Studies
EDAT- 2022/11/04 06:00
MHDA- 2023/03/28 06:00
CRDT- 2022/11/03 20:33
PHST- 2022/04/07 00:00 [received]
PHST- 2022/10/08 00:00 [revised]
PHST- 2022/10/20 00:00 [accepted]
PHST- 2022/11/04 06:00 [pubmed]
PHST- 2023/03/28 06:00 [medline]
PHST- 2022/11/03 20:33 [entrez]
AID - S0016-5107(22)02130-7 [pii]
AID - 10.1016/j.gie.2022.10.038 [doi]
PST - ppublish
SO  - Gastrointest Endosc. 2023 Apr;97(4):713-721.e6. doi: 10.1016/j.gie.2022.10.038. 
      Epub 2022 Nov 1.