Khashab Mouen A, Messallam Ahmed A, Penas Irene, Nakai Yousuke, Modayil Rani J, De la Serna Carlos, Hara Kazuo, El Zein Mohamad, Stavropoulos Stavros N, Perez-Miranda Manuel, Kumbhari Vivek, Ngamruengphong Saowanee, Dhir Vinay K, Park Do Hyun
Johns Hopkins Medical Institutions, Baltimore, MD, United States.
Hospital Universitario-Roi Hortega, Valladolid, Spain.
Endosc Int Open. 2016 Feb;4(2):E175-81. doi: 10.1055/s-0041-109083. Epub 2016 Jan 15.
Endoscopic ultrasound-guided biliary drainage (EUS-BD) can be performed entirely transgastrically (hepatogastrostomy/EUS-HG) or transduodenally (choledochoduodenostomy/EUS-CDS). It is unknown how both techniques compare. The aims of this study were to compare efficacy and safety of both techniques and identify predictors of adverse events.
Consecutive jaundiced patients with distal malignant biliary obstruction who underwent EUS-BD at multiple international centers were included. Technical/clinical success, adverse events, stent complications, and survival were assessed.
A total of 121 patients underwent EUS-BD (CDS 60, HG 61). Technical success was achieved in 112 (92.56 %) patients (EUS-CDS 93.3 %, EUS-HG 91.8 %, P = 0.75). Clinical success was attained in 85.5 % of patients who underwent EUS-CDS group as compared to 82.1 % of patients who underwent EUS-HG (P = 0.64). Adverse events occurred more commonly in the EUS-HG group (19.67 % vs. 13.3 %, P = 0.37). Both plastic stenting (OR 4.95, 95 %CI 1.41 - 17.38, P = 0.01) and use of non-coaxial electrocautery (OR 3.95, 95 %CI 1.16 - 13.40, P = 0.03) were independently associated with adverse events. Length of hospital stay was significantly shorter in the CDS group (5.6 days vs. 12.7 days, P < 0.001). Mean follow-up duration was 151 ± 159 days. The 1-year stent patency probability was greater in the EUS-CDS group [0.98 (95 %CI 0.76 - 0.96) vs 0.60 (95 %CI 0.35 - 0.78)] but overall patency was not significantly different. There was no difference in median survival times between the groups (P = 0.36) CONCLUSIONS: Both EUS-CDS and EUS-HG are effective and safe techniques for the treatment of distal biliary obstruction after failed ERCP. However, CDS is associated with shorter hospital stay, improved stent patency, and fewer procedure- and stent-related complications. Metallic stents should be placed whenever feasible and non-coaxial electrocautery should be avoided when possible as plastic stenting and non-coaxial electrocautery were independently associated with occurrence of adverse events.
内镜超声引导下胆道引流（EUS-BD）可完全经胃进行（肝胃吻合术/EUS-HG）或经十二指肠进行（胆总管十二指肠吻合术/EUS-CDS）。目前尚不清楚这两种技术的比较情况。本研究的目的是比较这两种技术的疗效和安全性，并确定不良事件的预测因素。
纳入在多个国际中心接受EUS-BD的连续性远端恶性胆管梗阻黄疸患者。评估技术/临床成功率、不良事件、支架并发症和生存率。
共有121例患者接受了EUS-BD（CDS组60例，HG组61例）。112例（92.56%）患者获得技术成功（EUS-CDS组93.3%，EUS-HG组91.8%，P = 0.75）。EUS-CDS组85.5%的患者获得临床成功，而EUS-HG组为82.1%（P = 0.64）。不良事件在EUS-HG组中更常见（19.67%对13.3%，P = 0.37）。塑料支架置入（比值比4.95，95%可信区间1.41 - 17.38，P = 0.01）和使用非同轴电灼（比值比3.95，95%可信区间1.16 - 13.40，P = 0.03）均与不良事件独立相关。CDS组的住院时间明显更短（5.6天对12.7天，P < 0.001）。平均随访时间为151 ± 159天。EUS-CDS组的1年支架通畅概率更高[0.98（95%可信区间0.76 - 0.96）对0.60（95%可信区间0.35 - 0.78）]，但总体通畅率无显著差异。两组之间的中位生存时间无差异（P = 0.36）。结论：EUS-CDS和EUS-HG都是治疗ERCP失败后远端胆管梗阻的有效且安全的技术。然而，CDS与更短的住院时间、更好的支架通畅性以及更少的手术和支架相关并发症相关。只要可行，应放置金属支架，并且尽可能避免使用非同轴电灼，因为塑料支架置入和非同轴电灼与不良事件的发生独立相关。
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