在胰十二指肠切除术（PD）前，内窥镜逆行胆管胰管造影术（ERCP）行术前胆管引流（PBD）是否等同于电灼增强腔内嵌金属支架（ECE-LAMS）目前尚不清楚。 于2015年至2022年间，在九个专家中心进行了回顾性研究，将行PD的远端恶性胆管梗阻（DMBO）病人纳入研究。进行了ERCP或内窥超声引导的胆总管十二指肠吻合术并放置ECE-LAMS。在意图治疗分析中，将使用ECE-LAMS引流的患者视为研究组（第一LAMS组），而使用传统经导管置入支架引流的患者则为对照组（第一穿刺组）。分析了技术成功率、临床成功率、引流相关并发症、手术并发症和肿瘤结果等因素。在156名患者中，128名接受了ERCP，28名首次进行了ECE-LAMS。第一穿刺组的技术成功率和临床成功率分别为83.5％和70.2％，而第一LAMS组则为100％和89.3％（分别为p = 0.02和p = 0.05）。在整个患者旅程中，第一穿刺组的总并发症率为93.7％，而第一LAMS组为92.0％（p = 0.04）。第一穿刺组的整体内镜并发症率为30.5％，而第一LAMS组为17.9％（p = 0.25）。PD后的总体并发症率在第一穿刺组中高于第一LAMS组（92.2％与75.0％，p = 0.016）。两组的总体生存率和无进展生存率没有差异。PBD与ECE-LAMS在DMBO患者中部署更容易、更有效。在不损害肿瘤结果的情况下，它可减少胰十二指肠切除术后手术并发症的发生率。©2023年，外科肿瘤学会。

It is unclear whether preoperative biliary drainage (PBD) by endoscopic retrograde cholangiopancreatography (ERCP) is equivalent to electrocautery-enhanced lumen-apposing metal stent (ECE-LAMS) before pancreatoduodenectomy (PD).Patients who underwent PBD for distal malignant biliary obstruction (DMBO) followed by PD were retrospectively included in nine expert centers between 2015 and 2022. ERCP or endoscopic ultrasound-guided choledochoduodenostomy with ECE-LAMS were performed. In intent-to-treat analysis, patients drained with ECE-LAMS were considered the study group (first-LAMS group) and those drained with conventional transpapillary stent the control group (first-cannulation group). The rates of technical success, clinical success, drainage-related complications, surgical complications, and oncological outcomes were analyzed.Among 156 patients, 128 underwent ERCP and 28 ECE-LAMS in first intent. The technical and clinical success rates were 83.5% and 70.2% in the first-cannulation group versus 100% and 89.3% in the first-LAMS group (p = 0.02 and p = 0.05, respectively). The overall complication rate over the entire patient journey was 93.7% in first-cannulation group versus 92.0% in first-LAMS group (p = 0.04). The overall endoscopic complication rate was 30.5% in first-cannulation group versus 17.9% in first-LAMS group (p = 0.25). The overall complication rate after PD was higher in the first-cannulation group than in the first-LAMS group (92.2% versus 75.0%, p = 0.016). Overall survival and progression-free survival did not differ between the groups.PBD with ECE-LAMS is easier to deploy and more efficient than ERCP in patients with DMBO. It is associated with less surgical complications after pancreatoduodenectomy without compromising the oncological outcome.© 2023. Society of Surgical Oncology.