Tesis

Proporsi dan Karakteristik Pasien Obstruksi Bilier Maligna yang Mengalami Disfungsi Stent Plastik Pasca Menjalani Drainase Bilier melalui Ultrasonografi Endoskopik (EUS-BD) = Proportion and Characteristics of Malignant Biliary Obstruction Patients Experiencing Plastic Stent Dysfunction after Endoscopic Ultrasound-Guided Biliary Drainage (EUS-BD).

Latar Belakang: Pemasangan stent melalui Endoscopic ultrasound-guided biliary drainage (EUS-BD) dapat menjadi alternatif jika endoscopic retrograde cholangiopancreatography (ERCP) gagal dilakukan pada pasien obstruksi bilier maligna. Stent bilier yang terpasang dapat mengalami disfungsi dan terdapat beberapa faktor yang dapat meningkatkan risiko tersebut. Tujuan: Mengetahui proporsi disfungsi stent awitan dini ( < 30 hari) dan awitan lambat ( > 90 hari), karakteristik pasien yang mengalami disfungsi stent, dan rerata durasi patensi, serta median waktu hingga disfungsi stent pada pasien obstruksi bilier maligna pasca menjalani pemasangan stent plastik melalui EUS-BD. Metode: Penelitian ini menggunakan desain kohort retrospektif. Data diperoleh dari rekam medis periode Januari 2015 hingga Desember 2024. Data dianalisis menggunakan SPSS dengan metode analisis deskriptif dan analisis kesintasan kaplan-meier. Hasil: Dari 44 subjek didapatkan proporsi disfungsi stent awitan dini pada 3/26 subjek (11,5%), dan awitan lambat pada 10/17 subjek (58,8%). Didapatkan rerata usia pada disfungsi stent awitan dini adalah 48 (12,12) tahun dan pada awitan lambat adalah 52,25 (8,14) tahun. Proporsi laki-laki lebih banyak pada awitan dini (2 dari 3 subjek), dan seimbang pada awitan lambat (masing-masing 5 subjek). Pada subjek dengan disfungsi stent awitan dini dan lambat didapatkan jenis kanker terbanyak adalah adenokarsinoma kaput pankreas (2 dan 7 subjek), memiliki keterlibatan duodenum (3 dan 10 subjek), tumor unresectable (3 dan 8 subjek), kanker stadium 4 (2 dan 5 subjek), menggunakan teknik hepaticogastrostomy (HGS) (2 dan 10 subjek), tanpa asites (2 dan 10 subjek), dan tidak menerima kemoterapi (3 dan 9 subjek). Pada awitan dini lebih banyak tanpa kolangitis akut (2/3 subjek), sementara pada awitan lambat lebih banyak mengalami kolangitis akut (9/10 subjek). rerata durasi patensi stent adalah 114,95 hari (IK 95% 70,83–159,07), dan median waktu hingga disfungsi stent adalah 57 hari (IK 95% 20,5–93,5). Kesimpulan: Proporsi disfungsi stent awitan dini sebesar 11,5% dan awitan lambat sebesar 58,8%. Sebagian besar subjek dengan adenokarsinoma kaput pankreas, memiliki keterlibatan duodenum, tumor unresectable, kanker stadium 4, menggunakan teknik HGS, tanpa asites, dan tidak menerima kemoterapi. Subjek pada awitan dini lebih banyak tanpa kolangitis akut, sementara pada awitan lambat lebih banyak mengalami kolangitis akut. Median waktu hingga disfungsi stent adalah 57 hari, dan rerata durasi patensi stent adalah 114,95 hari.
Kata Kunci: EUS-BD; obstruksi bilier maligna; disfungsi stent plastik


Background: Stent placement via Endoscopic ultrasound-guided biliary drainage (EUS-BD) has become an alternative when endoscopic retrograde cholangiopancreatography (ERCP) fails in patients with malignant biliary obstruction. Biliary stents may develop dysfunction, and several factors may increase the risk. Objective: To determine the proportion of early-onset stent dysfunction ( < 30 days) and late-onset stent dysfunction ( > 90 days), the characteristics of patients who developed stent dysfunction, the mean duration of stent patency and median time to stent dysfunction in patients with malignant biliary obstruction undergoing plastic stent placement via EUS-BD. Methods: This was a retrospective cohort study. Data were obtained from medical records between January 2015 and December 2024. Data were analyzed using SPSS with descriptive statistics and kaplan-meier survival analysis. Results: Among 44 subjects, early-onset stent dysfunction was observed in 3 of 26 subjects (11.5%), while late-onset stent dysfunction occurred in 10 of 17 subjects (58.5%). The mean age of subjects with early-onset stent dysfunction was 48 (12.12) years, and 52.25 (8.14) years for those with late-onset dysfunction. Males were more prevalent in the early dysfunction group (2 of 3 subjects), while sex distribution was equal in the late dysfunction group (5 subjects each). In both groups, the most common malignancy was adenocarcinoma of pancreatic head (2 and 7 subjects), with duodenal involvement (3 and 10 subjects), unresectable tumors (3 and 8 subjects), stage IV cancer (2 and 5 subjects), use of the hepaticogastrostomy (HGS) technique (2 and 10 subjects), absence of ascites (2 and 10 subjects), and no chemotherapy (3 and 9 subjects). Acute cholangitis was less frequent in the early-onset dysfunction group (2 of 3 subjects), but more common in the late-onset dysfunction group (9 of 10 subjects). The mean stent patency duration was 114.95 days (95% CI 70.83–159.07), and the median time to stent dysfunction was 57 days (95% CI 20.5–93.5). Conclusion: The proportion of early-onset stent dysfunction was 11.5% and lateonset stent dysfunction was 58.8%. Most subjects had adenocarcinoma of pancreatic head, duodenal involvement, unresectable tumors, stage IV cancer, underwent the HGS technique, had no ascites, and did not receive chemotherapy. Patients with early-onset dysfunction more often did not have acute cholangitis, while those with late-onset dysfunction more frequently developed acute cholangitis. The median time to stent dysfunction was 57 days, and the mean stent patency duration was 114.95 days.
Keywords: EUS-BD; malignant biliary obstruction; plastic stent dysfunction