Itoi Takao, Itokawa Fumihide, Sofuni Atsushi, Kurihara Toshio, Tsuchiya Takayoshi, Ishii Kentaro, Tsuji Shujiro, Ikeuchi Nobuhito, Moriyasu Fuminori
Department of Gastroenterology and Hepatology, Tokyo Medical University Shinjuku-ku, Nishishinjuku 6-7-1, Tokyo 160-0023, Japan.
World J Gastroenterol. 2008 Oct 21;14(39):6078-82. doi: 10.3748/wjg.14.6078.
Endoscopic ultrasonography (EUS)-guided biliary drainage was performed for treatment of patients who have obstructive jaundice in cases of failed endoscopic retrograde cholangiopancreatography (ERCP). In the present study, we introduced the feasibility and outcome of EUS-guided choledochoduodenostomy in four patients who failed in ERCP. We performed the procedure in 2 papilla of Vater, including one resectable case, and 2 cases of cancer of the head of pancreas. Using a curved linear array echoendoscope, a 19 G needle or a needle knife was punctured transduodenally into the bile duct under EUS visualization. Using a biliary catheter for dilation, or papillary balloon dilator, a 7-Fr plastic stent was inserted through the choledochoduodenostomy site into the extrahepatic bile duct. In 3 (75%) of 4 cases, an indwelling plastic stent was placed, and in one case in which the stent could not be advanced into the bile duct, a naso-biliary drainage tube was placed instead. In all cases, the obstructive jaundice rapidly improved after the procedure. Focal peritonitis and bleeding not requiring blood transfusion was seen in one case. In this case, pancreatoduodenectomy was performed and the surgical findings revealed severe adhesion around the choledochoduodenostomy site. Although further studies and development of devices are mandatory, EUS-guided choledochoduodenostomy appears to be an effective alternative to ERCP in selected cases.
对于内镜逆行胰胆管造影术（ERCP）失败的梗阻性黄疸患者，采用超声内镜（EUS）引导下胆道引流进行治疗。在本研究中，我们介绍了4例ERCP失败患者行EUS引导下胆总管十二指肠吻合术的可行性及结果。我们对2例十二指肠乳头进行了该手术，其中1例为可切除病例，2例为胰头癌。使用弯曲线阵超声内镜，在EUS直视下经十二指肠将19G穿刺针或针刀穿刺入胆管。使用胆道扩张导管或乳头球囊扩张器，通过胆总管十二指肠吻合部位将7F塑料支架置入肝外胆管。4例患者中有3例（75%）放置了留置塑料支架，1例支架无法推进至胆管，改为放置鼻胆管引流管。所有病例术后梗阻性黄疸均迅速改善。1例出现局限性腹膜炎和无需输血的出血。在该病例中，进行了胰十二指肠切除术，手术所见显示胆总管十二指肠吻合部位周围严重粘连。尽管必须进一步开展研究和改进设备，但EUS引导下胆总管十二指肠吻合术在特定病例中似乎是ERCP的有效替代方法。
