Efficacy Analysis Of ERCP Biliary Bougie Dilation Combined With Metal Stent Implantation In The Treatment Of Malignant Biliary Obstruction

Objective:To investigate the effect of ERCP biliary bougie dilation combined with metal stent implantation in the treatment of patients with malignant biliary obstruction,in order to provide guidance for the clinical treatment of patients with malignant biliary obstruction.Methods:The clinical data of patients with malignant biliary obstruction who underwent 60 biliary metal stent implantation in the First Hospital of Shanxi Medical University from January 2020 to December 2022 were divided into two groups according to different treatment methods: biliary metal stent implantation and biliary bougie dilation combined with metal stent implantation.Before and after the treatment(1 week after surgery)(alanine aminotransferase(ALT)、 aspartate aminotransferase(AST)、 total bilirubin(TBIL)、direct bilirubin(DBIL)、alkaline phosphatase(ALP)、γ-glutamine transferase(γ-GT),postoperative complications,the length of hospital stay and cost of hospitalization,survival and stent patency time were recorded by telephone、outpatient visit or inpatient record,with a total follow-up time of one year.Results:1.There was no significant difference in the preoperative ALT、AST、 TBIL、 DBIL、 ALP and γ-GT between the simple metal stent implantation group and the biliary bougie dilation combined with metal stent implantation group(P> 0.05).Compared with the preoperative period,the liver function laboratory indexes of the two groups decreased significantly one week after surgery,and the difference was statistically significant(P<0.05).There was no significant difference in the postoperative ALT、AST、TBIL and DBIL decreases between the two groups(P>0.05),but the ALP and γ-GT in the biliary bougie dilation combined with metal stent group at one week after surgery was significantly lower than that in the metal stent group(P<0.05).2.The surgery went smoothly in both groups and the incidence rates of postoperative pancreatitis,cholangitis,postoperative bleeding and other complications(one case had fever)in the metal stent group was 10.34%(3/29)、6.90%(2/29)、0%(0/29)and 3.45%(1/29),respectively.The incidence rates of pancreatitis 、 cholangitis 、 postoperative hemorrhage and other complications(one case had fever and two cases had abdominal pain)in the biliary bougie dilation combined with metal stent group were 6.45%(2/31)、12.90%(4/31)、6.45%(2/31)and 9.68%(3/31),respectively,and the complication rates in the two groups were similar,and the difference was not statistically significant(P>0.05).3.All patients were followed and we found that: the patency time of metal stent group was(196.11±44.59)days,and the survival rates of six months and twelve months after surgery were 62.07%(18/29)and 37.93%(11/29),respectively.The patency time of the biliary bougie dilation combined with metal stent group was(207.10±44.21)days,and the survival rates of six months and twelve months after surgery were 70.97%(22/31)and 32.26%(10/31),respectively.Compared with the metal stent group,there were no significant differences in stent patency time and survival rates at six months and twelve months after surgery in the biliary bougie dilation combined with the metal stent group(P>0.05).4.The median length of hospital stay(first quartile,third quartile)of biliary bougie dilation combined with metal stent group was 16(13,23)days,and the median cost of hospitalization(first quartile,third quartile)was 48073.41(40147.53,60234.59)yuan.The median length of hospital stay(first quartile,third quartile)in the metal stent group was 18(14.5,27)days,and the median cost of hospitalization(first quartile,third quartile)was 44615.21(32959.06,60151.65)yuan.There was no statistically significant difference in length of hospital stay and cost of hospitalization between the two groups(P>0.05).Conclusion:ERCP biliary bougie dilation combined with metal stent implantation is safe and effective in the treatment of malignant biliary obstruction,significantly improve the liver function,and its biliary decompression effect is better than that of simple metal stent implantation,which is worthy of clinical promotion and application,but attention should be paid to the occurrence of complications such as postoperative bleeding and abdominal pain.