title: Predictive factors for pancreatitis and cholecystitis in endoscopic covered metal stenting for distal malignant biliary obstruction.
abstract: OBJECTIVE
  Pancreatitis and cholecystitis are major complications after self-expandable metal stent (SEMS) placement in distal malignant biliary obstruction. We aimed to clarify predictive factors for pancreatitis and cholecystitis after covered SEMS placement.
  
  
  METHODS
  We retrospectively reviewed 74 consecutive patients with distal malignant biliary obstruction who underwent initial endoscopic drainage using covered SEMS. Predictive factors for pancreatitis and cholecystitis were evaluated in the 74 patients described above and in 66 patients who had not undergone cholecystectomy.
  
  
  RESULTS
  The incidences of pancreatitis and cholecystitis were 10.8% (8/74) and 6.1% (4/66), respectively. Univariate analysis revealed that non-pancreatic cancer (P = 0.018) and contrast injection into the pancreatic duct (P = 0.030) were significant predictive factors for pancreatitis. Multivariate analysis revealed that non-pancreatic cancer (odds ratio [OR], 4.21; 95% confidence interval [CI], 1.63-14.18; P = 0.007) and contrast injection into the pancreatic duct (OR, 3.34; 95% CI, 1.33-9.60; P = 0.016) were significant independent predictive factors for pancreatitis. On the other hand, univariate and multivariate analyses revealed that tumor involvement to the orifice of the cystic duct (OCD) was a significant independent predictive factor for cholecystitis (OR, 5.85; 95% CI, 1.91-27.74; P = 0.005).
  
  
  CONCLUSIONS
  Non-pancreatic cancer and contrast injection into the pancreatic duct were predictive factors for pancreatitis, and tumor involvement to the OCD was a positive predictive factor for cholecystitis after endoscopic covered SEMS placement for distal malignant biliary obstruction.
authors.affiliation: Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Shuya
authors.initials: S
authors.lastname: Shimizu
authors.forename: Itaru
authors.initials: I
authors.lastname: Naitoh
authors.forename: Takahiro
authors.initials: T
authors.lastname: Nakazawa
authors.forename: Kazuki
authors.initials: K
authors.lastname: Hayashi
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Miyabe
authors.forename: Hiromu
authors.initials: H
authors.lastname: Kondo
authors.forename: Michihiro
authors.initials: M
authors.lastname: Yoshida
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Yamashita
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Umemura
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Hori
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Ohara
authors.forename: Takashi
authors.initials: T
authors.lastname: Joh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002764:Cholecystitis / Q000209:etiology*; D002779:Cholestasis / Q000209:etiology / Q000628:therapy*; D016001:Confidence Intervals; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects; D004067:Digestive System Neoplasms / Q000150:complications*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010195:Pancreatitis / Q000209:etiology*; D019919:Prosthesis Implantation / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*
chemical_list: D003287:Contrast Media