在恶性远端胆道梗阻 (MDBO) 中插入自膨式金属支架 (SEMS) 的内镜逆行胰胆管造影 (ERCP) 后，支架功能障碍很常见。先前已证明长期服用阿司匹林（ASA-E）可能会降低这种风险。我们的目的是进一步确定 ASA 的保护作用并确定支架功能障碍的其他预测因素。多中心回顾性队列研究（9 个加拿大和 1 个美国）。在 01/2014-12/2019 期间接受 ERCP-SEMS 的 MDBO 被纳入并分为两个队列：ASA-E 和 ASA 未暴露 (ASA-U)。进行倾向评分匹配（PSM）以限制选择偏差。匹配的变量包括：年龄、性别、肿瘤分期和金属支架类型。主要结果是支架功能障碍的风险率。使用多变量 Cox 比例风险模型来确定支架功能障碍的独立预测因子。对 1,396 名患者进行了评估。 PSM 后，总共对 496 名患者进行了分析（248 名 ASA-E，248 名 ASA-U）。 ERCP-SEMS 与 ASA-E 中 82.2% 的临床成功率和 ASA-U 中 81.2% 的临床成功率相关，p=0.80。共有 184 名患者出现支架功能障碍，ASA-E 和 ASA-U 的平均支架通畅时间分别为 229.9 ± 306.2 天和 245.4 ± 241.4 天（p=0.52）。在多变量分析中，ASA-E 不能预防支架功能障碍，风险比为 1.25（95% 置信区间，CI：0.96；1.63）。胰腺癌病因（HR 1.36，95% CI：1.15-1.61）预测支架功能障碍，而癌症治疗具有保护作用（HR 0.73，95% CI：0.55；0.96）。长期使用 ASA 与出血、ERCP 术后胰腺炎和穿孔等不良事件风险增加无关。在这项利用倾向评分匹配的大型多中心研究中，长期使用 ASA 并不能预防 MDBO 中的支架功能障碍。相反，分析显示，胰腺癌的病因是支架功能障碍的独立预测因素，而癌症治疗具有保护作用。版权所有 © 2023 美国胃肠内窥镜协会。由爱思唯尔公司出版。保留所有权利。

Stent dysfunction is common following endoscopic retrograde cholangiopancreatography (ERCP) with self-expanding metal stent (SEMS) insertion in malignant distal biliary obstruction (MDBO). Chronic aspirin exposure (ASA-E) has been previously shown to potentially decrease this risk. We aim to further ascertain the protective effect of ASA and to identify other predictors of stent dysfunction.Multicenter retrospective cohort study (9 Canada and 1 US). MDBO who underwent ERCP-SEMS between 01/2014-12/2019 were included and divided into two cohorts: ASA-E and ASA unexposed (ASA-U). Propensity score-matching (PSM) was performed to limit selection bias. Matched variables included: age, sex, tumor stage, and type of metal stent. The primary outcome was the hazard rate of stent dysfunction. A multivariable Cox proportional hazards model was used to identify independent predictors of stent dysfunction.1,396 patients were assessed. Following PSM a total of 496 patients were analyzed (248 ASA-E, 248 ASA-U). ERCP-SEMS was associated with high clinical success of 82.2% in ASA-E and 81.2% in ASA-U, p=0.80. A total of 184 patients had stent dysfunction wth a mean stent patency time of 229.9 ± 306.2 days and 245.4 ± 241.4 days in ASA-E and ASA-U, resepectively (p=0.52). On multivariable analysis, ASA-E did not protect against stent dysfunction with a hazard ratio of 1.25 (95% confidence interval, CI: 0.96; 1.63). Pancreatic cancer etiology (HR 1.36, 95% CI:1.15-1.61) predicted stent dysfunction while cancer therapy was protective (HR 0.73, 95% CI: 0.55; 0.96). The use of chronic ASA was not associated with an increased risk for adverse events including bleeding, post-ERCP pancreatitis, and perforation.In this large, multicenter study utilizing propensity score-matching, chronic exposure to ASA did not protect against stent dysfunction in MDBO. Instead, the analysis revealed that the etiology of pancreatic cancer was an independent predictor of stent dysfunction while cancer therapy was protective.Copyright © 2023 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.