Cai Jennifer X, Diehl David L, Kiesslich Ralf, Storm Andrew C, El Zein Mohamad H, Tieu Alan H, Hoffman Arthur, Singh Vikesh K, Khashab Mouen A, Okolo Patrick I, Kumbhari Vivek
Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Hospital, Johns Hopkins Medical Institutions, 1800 Orleans Street, Sheikh Zayed Tower 7E, Suite 7125G, Baltimore, MD, 21287, USA.
Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, PA, USA.
Surg Endosc. 2017 Jul;31(7):2753-2762. doi: 10.1007/s00464-016-5282-2. Epub 2016 Dec 30.
Surgically altered gastrointestinal anatomy poses challenges for deep enteroscopy. Current overtube-assisted methods have long procedure times and utilize endoscopes with smaller working channels that preclude use of standard accessories. A through-the-scope balloon-assisted enteroscopy (TTS-BAE) device uses standard endoscopes with a large working channel to allow metallic and plastic stent insertion. We aim to determine the efficacy and safety of TTS-BAE in patients with altered surgical anatomy.
A retrospective, multicenter study of TTS-BAE in altered anatomy patients at two USA and one German institution was performed between January 2013 and December 2014. Type of anatomy, procedure indication and duration, adverse events, and target, technical, and clinical success were recorded.
A total of 32 patients (mean age 54 years, Caucasian 81.6%, female 42.1%, mean BMI 25.4 kg/m) underwent 38 TTS-BAE procedures. Thirty-two percent of cases had a prior attempt at conventional enteroscopy which failed to reach the target site. The target was successfully reached in 23 (60.5%) cases. Of the 23 cases that reached the intended target, 22 (95.7%) achieved technical success and 21 (91.3%) achieved clinical success. The median procedure time was 43 min. Target, technical, and clinical success rates for TTS-BAE-assisted ERCP (n = 31) were 58.1, 54.8 and 54.8%. Seven self-expandable metallic stents (five biliary, two jejunal) were attempted, and all successfully deployed. Adverse events occurred in 4 (10.4%) cases, including one luminal perforation.
TTS-BAE is an alternative to overtube-assisted enteroscopy that is comparable in safety in patients with surgically altered anatomies. Technical success in the instances where the target had been reached was excellent. TTS-BAE confers an advantage over overtube-assisted enteroscopy as it can facilitate the deployment of self-expandable metallic stents in the biliary tree and deep small bowel.
手术改变的胃肠道解剖结构给深度肠镜检查带来了挑战。目前的外套管辅助方法操作时间长，且使用的内镜工作通道较小，无法使用标准附件。经内镜球囊辅助肠镜检查（TTS-BAE）设备使用具有大工作通道的标准内镜，以允许插入金属和塑料支架。我们旨在确定TTS-BAE在手术解剖结构改变患者中的有效性和安全性。
2013年1月至2014年12月期间，在美国两家机构和一家德国机构对手术解剖结构改变的患者进行了一项关于TTS-BAE的回顾性多中心研究。记录解剖类型、手术指征和持续时间、不良事件以及目标、技术和临床成功率。
共有32例患者（平均年龄54岁，白种人占81.6%，女性占42.1%，平均BMI为25.4kg/m）接受了38次TTS-BAE手术。32%的病例曾尝试过传统肠镜检查，但未能到达目标部位。23例（60.5%）成功到达目标。在23例到达预定目标的病例中，22例（95.7%）取得技术成功，21例（91.3%）取得临床成功。中位手术时间为43分钟。TTS-BAE辅助内镜逆行胰胆管造影（ERCP，n=31）的目标、技术和临床成功率分别为58.1%、54.8%和54.8%。尝试放置了7个自膨式金属支架（5个胆管支架，2个空肠支架），均成功置入。4例（10.4%）发生不良事件，包括1例肠腔穿孔。
TTS-BAE是外套管辅助肠镜检查的一种替代方法，在手术解剖结构改变的患者中安全性相当。在到达目标的情况下技术成功率很高。TTS-BAE比外套管辅助肠镜检查具有优势，因为它可以促进自膨式金属支架在胆管树和深部小肠中的置入。
