First Department of Internal Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan.
Dig Dis Sci. 2013 Aug;58(8):2417-22. doi: 10.1007/s10620-013-2645-6. Epub 2013 Mar 28.
Endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy is challenging. Several endoscopic ultrasound (EUS)-guided biliary access techniques have been reported as effective alternatives. EUS-guided antegrade treatments (AG) have been developed more recently but have not yet been studied well.
To evaluate the feasibility and safety of EUS-AG for biliary disorders in patients with surgically altered anatomies.
We retrospectively identified all the patients who underwent EUS-AG. The left intrahepatic bile duct (IHBD) was initially punctured from the intestine followed by cholangiography, antegrade guidewire manipulation, and bougie dilation of the fistula. Either antegrade biliary stenting (ABS) or antegrade balloon dilation (ABD) was performed depending on the biliary disorders. In stone cases, the stones were antegradely pushed out using a balloon. After ABD, a nasobiliary drainage tube was placed to prevent possible bile leak and to keep an access route for any possible repeat procedures.
EUS-AG was attempted in seven patients including choledocholithiasis in five, malignant biliary obstruction in one, and bilioenteric anastomosis stricture in one. EUS-AG was not performed in one patient because EUS-cholangiography did not indicate the presence of stones. In the remaining six patients, the IHBD was successfully punctured, followed by cholangiography, guidewire insertion, and bougie dilation. ABS and ABD were successfully performed in one and five patients, respectively. Antegrade procedures with ABD were repeated twice in one patient. Mild complications were observed in two patients.
EUS-AG for biliary disorders in patients with surgically altered anatomy is feasible. Further studies are warranted.
在解剖结构改变的患者中进行内镜逆行胰胆管造影术具有挑战性。已经报道了几种超声内镜 (EUS)-引导的胆道入路技术作为有效的替代方法。EUS-引导的顺行治疗 (AG) 最近才开发出来，但尚未得到很好的研究。
评估 EUS-AG 在解剖结构改变的患者胆道疾病中的可行性和安全性。
我们回顾性地确定了所有接受 EUS-AG 的患者。首先从肠道穿刺左肝内胆管 (IHBD)，然后进行胆管造影、顺行导丝操作和瘘管扩张。根据胆道疾病情况进行顺行胆道支架置入术 (ABS) 或顺行球囊扩张术 (ABD)。在结石病例中，使用球囊将结石顺行推出。ABD 后，放置鼻胆管引流管以防止可能的胆汁漏，并为任何可能的重复操作保留进入途径。
7 名患者尝试了 EUS-AG，其中 5 例为胆总管结石，1 例为恶性胆道梗阻，1 例为胆肠吻合口狭窄。1 名患者因 EUS 胆管造影未显示结石而未进行 EUS-AG。在其余 6 名患者中，成功穿刺 IHBD，随后进行胆管造影、导丝插入和球囊扩张。1 名患者成功进行 ABS，5 名患者成功进行 ABD。1 名患者进行了两次 ABD 顺行治疗。2 名患者出现轻微并发症。
EUS-AG 治疗解剖结构改变的患者胆道疾病是可行的。需要进一步研究。
