Digestive Disease Center, Department of Medicine, Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA.
Gastrointest Endosc. 2010 Nov;72(5):947-53. doi: 10.1016/j.gie.2010.07.016.
Information regarding the safety and feasibility of EUS-guided FNA (EUS/FNA) in surgically altered anatomy is limited.
The aim of this study was to describe EUS outcomes for Billroth I and II, Whipple, Puestow, Roux-en-Y (including gastric bypass), esophagectomy, and Nissen fundoplication surgeries.
Retrospective study.
Single tertiary-care center.
This study involved 188 EUS procedures performed in patients with surgically altered anatomy by 6 endosonographers from July 1995 to October 2008.
EUS and FNA.
Type of surgery, EUS indication, limitations to imaging, reasons for limitations, FNA results, and EUS/FNA complications.
Of 188 patients, 96 were men (mean age 57 years; range, 16-92 years). Of patients with Billroth II anatomy (n = 39), 10 had limited (common bile duct [CBD], head of pancreas [HOP]) imaging because intubation of the afferent limb failed (n = 6) or was not attempted (n = 4). Roux-en-Y (n = 18) encompased a variety of surgeries, but in general (n = 13) the proximal duodenum was not reached and the HOP and CBD were not imaged. For Roux-en-Y gastric bypass (n = 7), the HOP and CBD were not imaged, with the exception of 1 case (in which staple-line dehiscence permitted access to the proximal duodenum). For the remaining procedures, EUS and FNA were successful with few exceptions. There were no significant adverse events (95% confidence interval, 0% to 1.9%).
Retrospective descriptive study.
EUS is generally successful and safe in patients with surgically altered anatomy in this tertiary-care setting, and a very low rate of adverse events is possible. Exceptions included imaging the HOP and CBD after Roux-en-Y surgery. After Billroth II surgery, if the afferent limb was intubated, the majority of patients were able to have a complete pancreaticobiliary examination, including FNA.
关于内镜超声引导下细针抽吸术（EUS/FNA）在手术改变的解剖结构中的安全性和可行性的信息有限。
本研究的目的是描述 Billroth I 和 II、Whipple、Puestow、Roux-en-Y（包括胃旁路术）、食管切除术和 Nissen 胃底折叠术手术的 EUS 结果。
回顾性研究。
单中心三级保健中心。
本研究纳入了 1995 年 7 月至 2008 年 10 月期间由 6 名内镜超声医师对 188 例手术改变解剖结构患者进行的 188 次 EUS 检查。
EUS 和 FNA。
手术类型、EUS 适应证、成像受限、受限原因、FNA 结果和 EUS/FNA 并发症。
在 188 例患者中，96 例为男性（平均年龄 57 岁；范围，16-92 岁）。在 Billroth II 解剖结构的患者中（n=39），由于未尝试或无法将流入道插管（n=6）或未尝试插管（n=4），有 10 例存在有限的（胆总管[CBD]、胰头[HOP]）成像。 Roux-en-Y（n=18）包括各种手术，但一般来说（n=13）近端十二指肠未到达，胰头和 CBD 未成像。对于 Roux-en-Y 胃旁路术（n=7），未对胰头和 CBD 进行成像，除了 1 例（由于吻合线裂开允许进入近端十二指肠）。对于其余手术，EUS 和 FNA 均成功，仅有少数例外。无严重不良事件（95%置信区间，0%至 1.9%）。
回顾性描述性研究。
在该三级保健环境中，EUS 在手术改变的解剖结构患者中通常是安全有效的，并且可能出现非常低的不良事件发生率。例外情况包括 Roux-en-Y 手术后对胰头和 CBD 的成像。在 Billroth II 手术后，如果插入了流入道，大多数患者能够进行完整的胰胆检查，包括 FNA。
