Kanno Yoshihide, Ito Kei, Koshita Shinsuke, Ogawa Takahisa, Masu Kaori, Masaki Yoshiharu, Noda Yutaka
Yoshihide Kanno, Kei Ito, Shinsuke Koshita, Takahisa Ogawa, Kaori Masu, Yoshiharu Masaki, Yutaka Noda, Department of Gastroenterology, Sendai City Medical Center, Sendai, Miyagi 983-0824, Japan.
World J Gastrointest Endosc. 2017 Jul 16;9(7):304-309. doi: 10.4253/wjge.v9.i7.304.
To evaluate the efficacy of a newly developed dilator for endoscopic ultrasound (EUS)-guided drainage (ES Dilator).
Fourteen consecutive patients who had undergone EUS-guided choledochoduodenostomy (EUS-CDS) with the ES Dilator were identified from a prospectively maintained database and enrolled in the study group. Fourteen other patients who had undergone EUS-CDS without the dilator just prior to its introduction were analyzed as the control group. A historical cohort study was carried out comparing the two groups. The main outcome measurement was the procedure time. The technical success rate and early AE rate were also compared between the two groups.
There were no significant differences in age, sex and etiology of biliary obstruction. The utilization rate of a plastic stent was higher in the control group (36% 0%). The technical success rate was 100% in both groups. The mean procedure time was significantly shorter in the study group than in the control group (27 ± 7 min 44 ± 26 min, = 0.026). Additionally, there were no patients who required more than 40 min for the procedure in the study group. Early adverse events occurred in 29% (4/14) of the control group whereas none in the study group. The adverse events in all 4 patients was bile peritonitis, including pan-peritonitis in one patient. All patients recovered with conservative treatment by medication.
The newly developed dilator was found to be useful for shortening procedure time and would prevent adverse events related to bile leakage in EUS-CDS.
评估一种新开发的用于内镜超声（EUS）引导下引流的扩张器（ES扩张器）的疗效。
从一个前瞻性维护的数据库中识别出14例连续接受ES扩张器引导下的经内镜超声引导下胆总管十二指肠吻合术（EUS-CDS）的患者，并纳入研究组。另外14例在扩张器引入前仅接受了无扩张器的EUS-CDS的患者被作为对照组进行分析。进行了一项历史性队列研究以比较两组。主要结局指标是手术时间。还比较了两组之间的技术成功率和早期不良事件发生率。
两组在年龄、性别和胆道梗阻病因方面无显著差异。对照组塑料支架的使用率更高（36%对0%）。两组的技术成功率均为100%。研究组的平均手术时间显著短于对照组（27±7分钟对44±26分钟，P=0.026）。此外，研究组中没有患者手术时间超过40分钟。对照组有29%（4/14）发生早期不良事件，而研究组无不良事件发生。所有4例患者的不良事件均为胆汁性腹膜炎，其中1例为全腹膜炎。所有患者经药物保守治疗后康复。
新开发的扩张器被发现有助于缩短手术时间，并可预防EUS-CDS中与胆汁漏相关的不良事件。
