Brewer Gutierrez Olaya I, Nieto Jose, Irani Shayan, James Theodore, Pieratti Bueno Renata, Chen Yen-I, Bukhari Majidah, Sanaei Omid, Kumbhari Vivek, Singh Vikesh K, Ngamruengphong Saowanee, Baron Todd H, Khashab Mouen A
Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States.
Borland-Groover Clinic, Jacksonville, Florida, United States.
Endosc Int Open. 2017 Sep;5(9):E893-E899. doi: 10.1055/s-0043-115386. Epub 2017 Sep 13.
Double endoscopic bypass entails EUS-guided gastroenterostomy (EUS-GE) and EUS-guided biliary drainage (EUS-BD) in patients who present with gastric outlet and biliary obstruction. We report a multicenter experience with double endoscopic bypass.
Retrospective, multicenter series involving 3 US centers. Patients who underwent double endoscopic bypass for malignant gastric and biliary obstruction from 1/2015 to 12/2016 were included. Primary outcome was clinical success defined as tolerance of oral intake and resolution of cholestasis. Secondary outcomes included technical success, re-interventions and adverse events (AE).
Seven patients with pancreatic head cancer (57.1 % females; mean age 64.6 ± 12.5 years) underwent double endoscopic bypass. Four patients had EUS-GE and EUS-BD performed during the same session with a mean procedure time of 70 ± 20.4 minutes. EUS-GE and EUS-BD were technically successful in all patients, all of whom were able to tolerate oral intake with resolution of cholestasis in 6 (87.5 %). One patient had a repeat EUS-BD with normalization of bilirubin. There were no adverse events.
Double endoscopic bypass is feasible and effective when performed by experienced operators. Studies comparing this novel concept to existing techniques are warranted.
双内镜旁路手术包括对胃出口和胆道梗阻患者进行超声内镜引导下胃肠造口术（EUS-GE）和超声内镜引导下胆道引流术（EUS-BD）。我们报告了多中心双内镜旁路手术的经验。
一项涉及3个美国中心的回顾性多中心研究。纳入2015年1月至2016年12月期间因恶性胃和胆道梗阻接受双内镜旁路手术的患者。主要结局为临床成功，定义为能够经口进食且胆汁淤积消退。次要结局包括技术成功、再次干预和不良事件（AE）。
7例胰头癌患者（女性占57.1%；平均年龄64.6±12.5岁）接受了双内镜旁路手术。4例患者在同一次手术中进行了EUS-GE和EUS-BD，平均手术时间为70±20.4分钟。所有患者的EUS-GE和EUS-BD技术均成功，所有患者均能经口进食，6例（87.5%）胆汁淤积消退。1例患者再次接受EUS-BD，胆红素恢复正常。无不良事件发生。
由经验丰富的操作者进行双内镜旁路手术是可行且有效的。有必要开展将这一新技术与现有技术进行比较的研究。
