Kawakubo Kazumichi, Kawakami Hiroshi, Kuwatani Masaki, Kubota Yoshimasa, Kawahata Shuhei, Kubo Kimitoshi, Sakamoto Naoya
Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan.
Endoscopy. 2016 Feb;48(2):164-9. doi: 10.1055/s-0034-1393179. Epub 2015 Oct 30.
Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) has gained popularity as an alternative to percutaneous biliary drainage for patients in whom endoscopic retrograde cholangiopancreatography has failed. There are no previous studies comparing EUS-CDS with endoscopic transpapillary stenting (ETS) as first-line treatment for distal malignant obstruction. The aim of this study was to compare the clinical efficacy and safety of EUS-CDS and ETS as first-line treatment in patients with distal malignant biliary obstruction.
A total of 82 patients with distal malignant biliary obstruction underwent initial biliary drainage using self-expandable metal stents at a tertiary care university hospital. ETS was performed between June 2009 and May 2012, and EUS-CDS was performed between May 2012 and March 2014. Clinical success rates, adverse event rates, and reintervention rates were retrospectively evaluated for EUS-CDS and ETS.
A total of 26 patients underwent EUS-CDS and 56 underwent ETS. Clinical success rates were equivalent between the groups (EUS-CDS 96.2 %, ETS 98.2 %; P = 0.54). The mean procedure time was significantly shorter with EUS-CDS than with ETS (19.7 vs. 30.2 minutes; P < 0.01). The rate of overall adverse events was not significantly different between the groups (EUS-CDS 26.9 %, ETS 35.7 %; P = 0.46). Post-procedural pancreatitis was only observed in the ETS group (0 % vs. 16.1 %; P = 0.03). The reintervention rate at 1 year was 16.6 % and 13.6 % for EUS-CDS and ETS, respectively (P = 0.50).
EUS-CDS performed by expert endoscopists was associated with a short procedure time and no risk of pancreatitis, and would therefore be feasible as a first-line treatment for patients with distal malignant biliary obstruction.
对于内镜逆行胰胆管造影失败的患者，内镜超声引导下胆总管十二指肠吻合术（EUS-CDS）作为经皮胆道引流的替代方法已受到广泛关注。此前尚无研究比较EUS-CDS与内镜下经乳头支架置入术（ETS）作为远端恶性梗阻一线治疗方法的疗效。本研究旨在比较EUS-CDS与ETS作为远端恶性胆管梗阻患者一线治疗方法的临床疗效和安全性。
在一家三级医疗大学医院，共有82例远端恶性胆管梗阻患者接受了使用自膨式金属支架的初始胆道引流。2009年6月至2012年5月期间进行了ETS，2012年5月至2014年3月期间进行了EUS-CDS。对EUS-CDS和ETS的临床成功率、不良事件发生率和再次干预率进行了回顾性评估。
共有26例患者接受了EUS-CDS，56例接受了ETS。两组的临床成功率相当（EUS-CDS为96.2%，ETS为98.2%；P = 0.54）。EUS-CDS的平均手术时间明显短于ETS（19.7分钟对30.2分钟；P < 0.01）。两组的总体不良事件发生率无显著差异（EUS-CDS为26.9%，ETS为35.7%；P = 0.46）。术后胰腺炎仅在ETS组中观察到（0%对16.1%；P = 0.03）。EUS-CDS和ETS在1年时的再次干预率分别为16.6%和13.6%（P = 0.50）。
由专业内镜医师进行的EUS-CDS手术时间短，且无胰腺炎风险，因此作为远端恶性胆管梗阻患者一线治疗方法是可行的。
