Makmun Dadang, Fauzi Achmad, Abdullah Murdani, Syam Ari Fahrial
Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta Pusat, Jakarta 10430, Indonesia.
Diagn Ther Endosc. 2017;2017:4856276. doi: 10.1155/2017/4856276. Epub 2017 Oct 18.
To evaluate the success rate and related factors of endoscopic ultrasound guided-biliary drainage (EUS-BD).
We conducted a retrospective study among 24 patients with malignant biliary obstruction who underwent EUS-BD after failed ERCP from January 2015 to December 2016 in a tertiary health center. The bilirubin levels before and after the procedure were used to define the clinical success rate, while the stent deployment was used to define the technical success rate. We placed either transluminal biliary stents or transpapillary biliary stents.
Among 24 patients, choledochoduodenostomy technique was conducted in 23 patients (95.8%) and hepaticogastrostomy technique in 1 patient (4.2%). Transluminal stent placement was conducted in 23 patients, while transpapillary stent placement was conducted in 1 patient. The clinical success rate was 78.2% (18) in choledochoduodenostomy route and 100% (1) in hepaticogastrostomy route. EUS-BD was 2.37 times and 2.11 times more likely to be successful in reducing the bilirubin level in patients with tumor of the head of pancreas and periampullary tumor, respectively, but not in cholangiocarcinoma.
EUS-BD is an effective and efficient procedure to achieve biliary drainage among patients with malignant biliary obstruction after ERCP failure.
评估内镜超声引导下胆道引流术（EUS-BD）的成功率及相关因素。
我们对2015年1月至2016年12月在一家三级医疗中心接受EUS-BD治疗且内镜逆行胰胆管造影（ERCP）失败的24例恶性胆道梗阻患者进行了一项回顾性研究。手术前后的胆红素水平用于定义临床成功率，而支架置入情况用于定义技术成功率。我们置入了腔内胆道支架或经乳头胆道支架。
24例患者中，23例（95.8%）采用了胆总管十二指肠吻合术，1例（4.2%）采用了肝胃吻合术。23例患者置入了腔内支架，1例患者置入了经乳头支架。胆总管十二指肠吻合术途径的临床成功率为78.2%（18例），肝胃吻合术途径的临床成功率为100%（1例）。EUS-BD在降低胰头肿瘤和壶腹周围肿瘤患者胆红素水平方面成功的可能性分别是胆管癌患者的2.37倍和2.11倍。
EUS-BD是ERCP失败后对恶性胆道梗阻患者进行胆道引流的一种有效且高效的方法。
