Sharaiha Reem Z, Kumta Nikhil A, Desai Amit P, DeFilippis Ersilia M, Gabr Moamen, Sarkisian Alex M, Salgado Sanjay, Millman Jennifer, Benvenuto Andrea, Cohen Michelle, Tyberg Amy, Gaidhane Monica, Kahaleh Michel
Department of Gastroenterology and Hepatology, New York Presbyterian-Weill Cornell Medical College, New York, NY, 10021, USA.
Surg Endosc. 2016 Dec;30(12):5500-5505. doi: 10.1007/s00464-016-4913-y. Epub 2016 Apr 29.
Patients with failed endoscopic retrograde cholangiopancreatography (ERCP) are conventionally offered percutaneous transhepatic biliary drainage (PTBD). While PTBD is effective, it is associated with catheter-related complications, pain, and poor quality of life. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is a minimally invasive endoscopic option increasingly offered as an alternative to PTBD. We compare outcomes of EUS-BD and PTBD in patients with biliary obstruction at a single tertiary care center.
A retrospective review was performed in patients with biliary obstruction who underwent EUS-BD or PTBD after failed ERCP from June 2010 through December 2014 at a single tertiary care center. Patient demographics, procedural data, and clinical outcomes were documented for each group. The aim was to compare efficacy and safety of EUS-BD and PTBD and evaluate predictors of success.
A total of 60 patients were included (mean age 67.5 years, 65 % male). Forty-seven underwent EUS-BD, and thirteen underwent PTBD. Technical success rates of PTBD and EUS-BD were similar (91.6 vs. 93.3 %, p = 1.0). PTBD patients underwent significantly more re-interventions than EUS-BD patients (mean 4.9 versus 1.3, p < 0.0001), had more late (>24-h) adverse events (53.8 % vs. 6.6 %, p = 0.001) and experienced more pain (4.1 vs. 1.9, p = 0.016) post-procedure. In univariate analysis, clinical success was lower in the PTBD group (25 vs. 62.2 %, p = 0.03). In multivariable logistic regression analysis, EUS-BD was the sole predictor of clinical success and long-term resolution (OR 21.8, p = 0.009).
Despite similar technical success rates compared to PTBD, EUS-BD results in a lower need for re-intervention, decreased rate of late adverse events, and lower pain scores, and is the sole predictor for clinical success and long-term resolution. EUS-BD should be the treatment of choice after a failed ERCP.
内镜逆行胰胆管造影术（ERCP）失败的患者通常会接受经皮经肝胆道引流术（PTBD）。虽然PTBD有效，但它与导管相关并发症、疼痛以及生活质量差有关。内镜超声引导下胆道引流术（EUS-BD）是一种微创内镜治疗选择，越来越多地被用作PTBD的替代方案。我们在一家三级医疗中心比较了EUS-BD和PTBD在胆道梗阻患者中的治疗效果。
对2010年6月至2014年12月在该三级医疗中心ERCP失败后接受EUS-BD或PTBD的胆道梗阻患者进行回顾性研究。记录每组患者的人口统计学资料、手术数据和临床结果。目的是比较EUS-BD和PTBD的疗效和安全性，并评估成功的预测因素。
共纳入60例患者（平均年龄67.5岁，65%为男性）。47例接受EUS-BD，13例接受PTBD。PTBD和EUS-BD的技术成功率相似（91.6%对93.3%，p = 1.0）。PTBD患者的再次干预次数明显多于EUS-BD患者（平均4.9次对1.3次，p < 0.0001），术后晚期（>24小时）不良事件更多（53.8%对6.6%，p = 0.001），且疼痛更严重（4.1对1.9，p = 0.016）。单因素分析显示，PTBD组的临床成功率较低（25%对62.2%，p = 0.03）。多变量逻辑回归分析显示，EUS-BD是临床成功和长期缓解的唯一预测因素（OR 21.8，p = 0.009）。
尽管与PTBD相比技术成功率相似，但EUS-BD导致再次干预的需求更低、晚期不良事件发生率降低且疼痛评分更低，并且是临床成功和长期缓解的唯一预测因素。ERCP失败后，EUS-BD应作为首选治疗方法。
