Umeda Junko, Itoi Takao, Tsuchiya Takayoshi, Sofuni Atsushi, Itokawa Fumihide, Ishii Kentaro, Tsuji Shujiro, Ikeuchi Nobuhito, Kamada Kentaro, Tanaka Reina, Tonozuka Ryosuke, Honjo Mitsuyoshi, Mukai Shuntaro, Fujita Mitsuru, Moriyasu Fuminori
Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
Gastrointest Endosc. 2015 Aug;82(2):390-396.e2. doi: 10.1016/j.gie.2015.02.041. Epub 2015 May 1.
There are currently no dedicated plastic stents for EUS-guided hepaticogastrostomy (EUS-HGS).
We prospectively evaluated the feasibility and the technical and functional success rates of our newly designed plastic stent for EUS-HGS.
Prospective preliminary feasibility study.
A tertiary-care referral center.
Twenty-three consecutive patients were treated. The reasons for requiring EUS-HGS were periampullary tumor invasion (n=9), altered anatomy (n=7), failed duodenal intubation (n=3), and previous ERCP failure (n=4).
An 8F single-pigtail plastic stent with 4 flanges was placed for EUS-HGS.
Technical success, clinical success, and adverse events according to the American Society for Gastrointestinal Endoscopy lexicon.
All stents were successfully deployed without procedural adverse events (100% technical success rate). Bleeding from the punctured gastric wall occurred in 1 patient 3 days postoperatively. We exchanged the plastic stent for a fully covered self-expandable metal stent. A mild adverse event of self-limited abdominal pain occurred in 3 patients. Treatment success was achieved in all patients. The occlusion rate was 13.7% (3/22) during the median follow-up period (5.0 months, range 0.5-12.5 months). The median duration of stent patency was 4.0 months (range 0.5-9.0 months). There was no stent migration or dislocation during the follow-up period.
Small number of patients and lack of a control group.
This newly designed single-pigtail plastic stent dedicated for EUS-HGS was technically feasible and can possibly be used for highly selected patients with advanced malignancy or benign stricture. (
http://www.umin.ac.jp/english/: UMIN000012993.).
目前尚无专门用于超声内镜引导下肝胃吻合术（EUS-HGS）的塑料支架。
我们前瞻性地评估了新设计的用于EUS-HGS的塑料支架的可行性、技术成功率和功能成功率。
前瞻性初步可行性研究。
一家三级医疗转诊中心。
连续23例患者接受治疗。需要进行EUS-HGS的原因包括壶腹周围肿瘤侵犯（n=9）、解剖结构改变（n=7）、十二指肠插管失败（n=3）和既往内镜逆行胰胆管造影（ERCP）失败（n=4）。
放置一个带有4个侧翼的8F单猪尾塑料支架用于EUS-HGS。
根据美国胃肠内镜学会词汇表定义的技术成功、临床成功和不良事件。
所有支架均成功置入，无手术相关不良事件（技术成功率100%）。1例患者术后3天出现穿刺胃壁出血。我们将塑料支架更换为全覆膜自膨式金属支架。3例患者出现自限性腹痛这一轻度不良事件。所有患者均获得治疗成功。在中位随访期（5.0个月，范围0.5 - 12.5个月）内，闭塞率为13.7%（3/22）。支架通畅的中位持续时间为4.0个月（范围0.5 - 9.0个月）。随访期间无支架移位或脱位。
患者数量少且缺乏对照组。
这种新设计的专门用于EUS-HGS的单猪尾塑料支架在技术上是可行的，可能适用于经过严格筛选的晚期恶性肿瘤或良性狭窄患者。（试验注册号：http://www.umin.ac.jp/english/: UMIN00001299）
