Iwashita Takuji, Nakai Yousuke, Hara Kazuo, Isayama Hiroyuki, Itoi Takao, Park Do Hyun
First Department of Internal Medicine, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan.
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
J Hepatobiliary Pancreat Sci. 2016 Apr;23(4):227-33. doi: 10.1002/jhbp.329. Epub 2016 Feb 29.
Endoscopic retrograde cholangiopancreatography (ERCP) for management of bile duct stone (BDS) in patients with surgically altered anatomy is challenging even when applying enteroscopy. Endoscopic ultrasound-guided antegrade treatments (EUS-AG) for BDS have been developed but have not been well studied yet. The aim of the present study was to evaluate the feasibility and safety of EUS-AG for BDS in patients with surgically altered anatomy as a multicenter retrospective cohort study.
A retrospective database analysis was performed to identify patients with surgically altered anatomy who underwent EUS-AG for the management of BDS at four academic care centers. Basic characteristics of the patients and details of the procedures were determined and the success rates and adverse event rates were evaluated.
EUS-AG for BDS was attempted in 29 patients. Successful BDS removal was achieved in 72% (21/29) of patients. Reasons for failed EUS-AG were unsuccessful bile duct puncture in six, unsuccessful guidewire manipulation in one, and unsuccessful stone removal using a retrieval balloon in one. Adverse events occurred in five (17%) but were successfully managed conservatively.
EUS-AG for BDS is a feasible and safe alternative in patients with surgically altered anatomy, although further evaluation and development of dedicated devices are needed.
即使应用小肠镜检查，在内镜逆行胰胆管造影术（ERCP）用于治疗解剖结构改变患者的胆管结石（BDS）时仍具有挑战性。内镜超声引导下顺行治疗（EUS-AG）BDS的方法已被开发出来，但尚未得到充分研究。本研究的目的是作为一项多中心回顾性队列研究，评估EUS-AG治疗解剖结构改变患者BDS的可行性和安全性。
进行回顾性数据库分析，以识别在四个学术医疗中心接受EUS-AG治疗BDS的解剖结构改变患者。确定患者的基本特征和手术细节，并评估成功率和不良事件发生率。
对29例患者尝试了EUS-AG治疗BDS。72%（21/29）的患者成功取出了BDS。EUS-AG失败的原因包括6例胆管穿刺失败、1例导丝操作失败和1例使用取石球囊取石失败。5例（17%）发生了不良事件，但通过保守治疗成功处理。
EUS-AG治疗BDS对于解剖结构改变的患者是一种可行且安全的替代方法，尽管需要对专用设备进行进一步评估和开发。
