Amano Mio, Ogura Takeshi, Onda Saori, Takagi Wataru, Sano Tastsushi, Okuda Astushi, Miyano Akira, Masuda Daisuke, Higuchi Kazuhide
Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
J Gastroenterol Hepatol. 2017 Mar;32(3):716-720. doi: 10.1111/jgh.13489.
On endoscopic ultrasound (EUS)-guided biliary drainage, fistula dilation may be accompanied by leakage of bile juice, potentially along with bacteria or air, so this procedure should be kept as simple and short as possible. To date, various techniques to dilate the fistula have been reported. This prospective, single-center, single-arm study evaluated the technical feasibility and safety of EUS-guided biliary drainage using novel balloon catheters.
Tip of novel balloon catheters is only 3 Fr and tapered, and the catheters also show favorable push ability. First, biliary tract was punctured using 19-G fine needle aspiration needle. Next, we immediately inserted the novel balloon catheter, and the biliary tract and intestinal wall were dilated. Then, we performed metallic stent placement without any dilation fistula.
A total of 20 patients were prospectively enrolled in this study. Technical success rate was 100%. Eleven patients underwent EUS-guided choledochoduodenostomy, and nine patients underwent EUS-guided hepaticogastrostomy. Median procedure time was only 11 min (range, 8-16 min) for EUS-guided choledochoduodenostomy and 14 min (range, 11-18 min) for EUS-guided hepaticogastrostomy. Adverse events were seen in 15% (3/20; self-limited abdominal pain n = 2, peritonitis n = 1).
Although additional cases and a randomized controlled comparison with another dilation technique such as the graded dilation or cystotome dilation technique are needed, our technique may be helpful for EUS-guided biliary drainage.
在内镜超声（EUS）引导下进行胆管引流时，瘘管扩张可能会伴有胆汁漏出，可能还会伴有细菌或空气，因此该操作应尽可能简单且耗时短。迄今为止，已有多种扩张瘘管的技术被报道。这项前瞻性、单中心、单臂研究评估了使用新型球囊导管进行EUS引导下胆管引流的技术可行性和安全性。
新型球囊导管的尖端仅3F且呈锥形，并且这些导管还具有良好的推送能力。首先，使用19G细针穿刺针穿刺胆管。接下来，我们立即插入新型球囊导管，并扩张胆管和肠壁。然后，我们在不进行任何瘘管扩张的情况下放置金属支架。
本研究共前瞻性纳入20例患者。技术成功率为100%。11例患者接受了EUS引导下的胆总管十二指肠吻合术，9例患者接受了EUS引导下的肝胃吻合术。EUS引导下胆总管十二指肠吻合术的中位操作时间仅为11分钟（范围8 - 16分钟），EUS引导下肝胃吻合术的中位操作时间为14分钟（范围11 - 18分钟）。15%（3/20）的患者出现不良事件（自限性腹痛2例，腹膜炎1例）。
尽管需要更多病例以及与另一种扩张技术（如分级扩张或切开刀扩张技术）进行随机对照比较，但我们的技术可能有助于EUS引导下的胆管引流。
