Department of Internal Medicine, School of Medicine, Wonkwang University, Iksan, Chonbuk 570-749, South Korea.
World J Gastroenterol. 2012 May 28;18(20):2526-32. doi: 10.3748/wjg.v18.i20.2526.
To determine the utility of endoscopic ultrasound-guided biliary drainage (EUS-BD) with a fully covered self-expandable metal stent for managing malignant biliary stricture.
We collected data from 13 patients who presented with malignant biliary obstruction and underwent EUS-BD with a nitinol fully covered self-expandable metal stent when endoscopic retrograde cholangiopancreatography (ERCP) fails. EUS-guided choledochoduodenostomy (EUS-CD) and EUS-guided hepaticogastrostomy (EUS-HG) was performed in 9 patients and 4 patients, respectively.
The technical and functional success rate was 92.3% (12/13) and 91.7% (11/12), respectively. Using an intrahepatic approach (EUS-HG, n = 4), there was mild peritonitis (n = 1) and migration of the metal stent to the stomach (n = 1). With an extrahepatic approach (EUS-CD, n = 10), there was pneumoperitoneum (n = 2), migration (n = 2), and mild peritonitis (n = 1). All patients were managed conservatively with antibiotics. During follow-up (range, 1-12 mo), there was re-intervention (4/13 cases, 30.7%) necessitated by stent migration (n = 2) and stent occlusion (n = 2).
EUS-BD with a nitinol fully covered self-expandable metal stent may be a feasible and effective treatment option in patients with malignant biliary obstruction when ERCP fails.
确定经内镜超声引导下胆道引流（EUS-BD）联合全覆膜自膨式金属支架在治疗恶性胆道狭窄中的应用价值。
我们收集了 13 例因内镜逆行胰胆管造影术（ERCP）失败而接受经内镜超声引导下胆道引流（EUS-BD）联合全覆膜自膨式金属支架治疗的恶性胆道梗阻患者的数据。9 例患者行 EUS 引导下胆肠吻合术（EUS-CD），4 例患者行 EUS 引导下肝胃吻合术（EUS-HG）。
技术成功率和功能成功率分别为 92.3%（12/13）和 91.7%（11/12）。采用肝内途径（EUS-HG，n=4）时，有 1 例发生轻微腹膜炎，1 例支架迁移至胃。采用肝外途径（EUS-CD，n=10）时，有 2 例发生气腹，2 例发生支架迁移，1 例发生轻微腹膜炎。所有患者均经抗生素保守治疗。在随访期间（1~12 个月），有 4 例（30.7%）需要再次干预，包括支架迁移（n=2）和支架阻塞（n=2）。
当 ERCP 失败时，EUS-BD 联合全覆膜自膨式金属支架可能是治疗恶性胆道梗阻的一种可行且有效的治疗选择。
