Iwashita Takuji, Yasuda Ichiro, Mukai Tsuyoshi, Iwata Keisuke, Doi Shinpei, Uemura Shinya, Mabuchi Masatoshi, Okuno Mitsuru, Shimizu Masahito
First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan.
Dig Endosc. 2017 May;29(3):362-368. doi: 10.1111/den.12800. Epub 2017 Feb 8.
Endoscopic retrograde cholangiography (ERCP) with biliary stenting for the treatment of unresectable malignant biliary obstruction (MBO) is challenging among patients with surgically altered anatomy. Endoscopic ultrasound-guided antegrade biliary stenting (EUS-ABS) was introduced as an alternative biliary drainage method, although it has not yet been well studied. In this single-center prospective pilot study, we aimed to evaluate the feasibility and safety of EUS-ABS for MBO in patients with surgically altered anatomy.
EUS-ABS for MBO was attempted in patients with surgically altered anatomy. In EUS-ABS, the bile duct in the left lobe was accessed from the intestine under EUS guidance, and a guidewire was placed. Thereafter, an uncovered metallic stent was deployed at the MBO through the fistula. All devices were then removed. Technical, clinical, and adverse event rates, as well as patient characteristics and procedure details, were evaluated.
Twenty patients (10 women; median age, 69 years) were enrolled in the present study. Technical and clinical success rates of EUS-ABS were both 95% (19/20). In one patient, unsuccessful EUS-ABS as a result of failed visualization of the left lobe of the liver with EUS was salvaged with percutaneous biliary drainage. Rate of adverse events was 20% (4/20), including mild pancreatitis in three patients and mild fever in one patient, which were successfully managed conservatively.
EUS-ABS for MBO in patients with surgically altered anatomy was a feasible and safe procedure. Further large scale comparison studies are needed to confirm its efficacy (Clinical Trial Registration Number: UMIN000008589).
对于手术解剖结构改变的患者，采用内镜逆行胆管造影术（ERCP）及胆道支架置入术治疗不可切除的恶性胆管梗阻（MBO）具有挑战性。内镜超声引导下顺行胆道支架置入术（EUS-ABS）作为一种替代性的胆道引流方法被引入，尽管其尚未得到充分研究。在这项单中心前瞻性初步研究中，我们旨在评估EUS-ABS用于手术解剖结构改变的MBO患者的可行性和安全性。
对手术解剖结构改变的患者尝试采用EUS-ABS治疗MBO。在EUS-ABS中，在EUS引导下经肠道进入左叶胆管，并置入导丝。此后，通过瘘口在MBO处置入无覆膜金属支架。然后取出所有器械。评估技术、临床和不良事件发生率，以及患者特征和手术细节。
本研究纳入了20例患者（10例女性；中位年龄69岁）。EUS-ABS的技术成功率和临床成功率均为95%（19/20）。1例患者因EUS未能显示肝脏左叶而导致EUS-ABS失败，随后采用经皮胆道引流挽救。不良事件发生率为20%（4/20），包括3例轻度胰腺炎和1例轻度发热，均经保守治疗成功处理。
EUS-ABS用于手术解剖结构改变的MBO患者是一种可行且安全的手术方法。需要进一步的大规模比较研究来证实其疗效（临床试验注册号：UMIN000008589）。
