Artifon Everson L A, Frazão Mariana S V, Wodak Stephanie, Carneiro Fred Olavo A A, Takada Jonas, Rabello Carolina, Aparício Dayse, de Moura Eduardo Guimarães Hourneaux, Sakai Paulo, Otoch José Pinhata
Gastrointestinal Endoscopy Unit, University of São Paulo Medical School, São Paulo, Brazil.
Scand J Gastroenterol. 2013 Mar;48(3):374-9. doi: 10.3109/00365521.2012.763176. Epub 2013 Jan 28.
Describe a case series of endoscopic ultrasound (EUS)-guided choledochoduodenostomy (EUS-CD) associated with duodenal self-expandable metal stents (SEMS) placement using solely the linear echoendoscope in seven patients with obstructive jaundice and duodenal obstruction due to unresectable periampullary cancer.
EUS-CD in the first portion of the duodenum, associated with duodenal SEMS placement was performed in seven patients with unresectable periampullary cancer with obstructive jaundice and invasive duodenal obstruction. Laboratory tests and clinical follow-up were performed until patient's death. The procedure was performed by an experienced endoscopist under conscious sedation. The puncture position was chosen based on EUS evaluation, at the common bile duct (CBD) above the tumor, through the distal part of the duodenal bulb. After that, the needle was withdrawn and a wire-guided needle knife was used to enlarge the site puncture in the duodenal wall. Then, a partially covered SEMS was passed over the guide, through the choledochoduodenal fistula. Duodenal SEMS placement was performed during the same endoscopic procedure.
The procedure was performed in seven patients, ranging between 34 and 86 years. Technical success of EUS-CD, by the stent placement, occurred in 100% of the cases. There were no early complications. Duodenal SEMS placement was effective in 100% of the cases that remained alive after a follow-up of 7 and 30 days.
The results suggest therapeutic EUS one-step procedure drainage as an alternative for these patients, with good clinical success, feasible technique and safety.
描述一系列经内镜超声（EUS）引导下胆总管十二指肠吻合术（EUS-CD）联合十二指肠自膨式金属支架（SEMS）置入术的病例，该系列病例仅使用线性超声内镜，共纳入7例因不可切除的壶腹周围癌导致梗阻性黄疸和十二指肠梗阻的患者。
对7例患有不可切除的壶腹周围癌且伴有梗阻性黄疸和浸润性十二指肠梗阻的患者，在十二指肠第一部进行EUS-CD，并联合十二指肠SEMS置入术。进行实验室检查和临床随访直至患者死亡。该操作由经验丰富的内镜医师在清醒镇静下进行。根据EUS评估结果，选择在肿瘤上方的胆总管（CBD）处、通过十二指肠球部远端进行穿刺。之后，拔出穿刺针，使用导丝引导的针刀扩大十二指肠壁上的穿刺部位。然后，将部分覆盖的SEMS沿导丝推送，通过胆总管十二指肠瘘。在同一内镜操作过程中进行十二指肠SEMS置入。
7例患者接受了该操作，年龄在34至86岁之间。通过支架置入，EUS-CD的技术成功率为100%。无早期并发症。在随访7天和30天后仍存活的病例中，十二指肠SEMS置入的有效率为100%。
结果表明，治疗性EUS一步法引流术可作为这些患者的一种替代方法，临床成功率高、技术可行且安全。
