Mizukawa Sho, Tsutsumi Koichiro, Kato Hironari, Muro Shinichiro, Akimoto Yutaka, Uchida Daisuke, Matsumoto Kazuyuki, Tomoda Takeshi, Horiguchi Shigeru, Okada Hiroyuki
Department of Gastroenterology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama-city, Okayama, 700-8558, Japan.
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
BMC Gastroenterol. 2018 Jan 18;18(1):14. doi: 10.1186/s12876-018-0742-x.
Endoscopic retrograde cholangiography using a short double-balloon endoscope (DB-ERC) is a promising minimally-invasive method for accessing hepaticojejunostomy (HJ) anastomosis in patients with surgically altered anatomy. We aimed to evaluate the immediate and long-term outcomes of balloon dilatation for benign HJ anastomotic stricture (HJAS) in patients who had previously undergone Whipple's procedure using a DB-ERC.
We conducted a retrospective analysis of 46 patients who underwent balloon dilatation alone with a DB-ERC for benign HJAS between November 2008 and November 2014. The median follow-up duration was 3.5 (interquartile range [IQR], 1.9-5.1) years.
The technical and clinical success rates were 100%, and adverse events occurred in 7% (3/46, cholangitis). The median hospitalization period was seven (IQR, 5-10) days. Of 42 patients (91%) followed-up for > 1 year, 24 (51%) had recurrent HJAS at a median of 1.2 (IQR, 0.6-2.9) years after balloon dilatation. The cumulative anastomotic patency rates at 1, 2, and 3 years were 73, 55, and 49%, respectively. In univariate analysis, early stricture formation (< 1 year) was a risk factor for recurrent stenosis, although no statistically significant risk factors were observed in multivariate analysis.
Endoscopic balloon dilatation with DB-ERC for benign HJAS is effective and safe, having good immediate technical success and few adverse events. Further improvements to this procedure are needed to prevent recurrent HJAS.
使用短双气囊内镜（DB-ERC）进行内镜逆行胆管造影术是一种有前景的微创方法，用于在手术改变解剖结构的患者中进入肝空肠吻合术（HJ）吻合口。我们旨在评估使用DB-ERC对先前接受过Whipple手术的患者的良性HJ吻合口狭窄（HJAS）进行球囊扩张的近期和长期结果。
我们对2008年11月至2014年11月期间46例仅使用DB-ERC进行球囊扩张治疗良性HJAS的患者进行了回顾性分析。中位随访时间为3.5（四分位间距[IQR]，1.9 - 5.1）年。
技术成功率和临床成功率均为100%，不良事件发生率为7%（3/46，胆管炎）。中位住院时间为7（IQR，5 - 10）天。在42例（91%）随访超过1年的患者中，24例（51%）在球囊扩张后中位1.2（IQR，0.6 - 2.9）年出现复发性HJAS。1年、2年和3年的累积吻合口通畅率分别为73%、55%和49%。单因素分析中，早期狭窄形成（<1年）是复发性狭窄的危险因素，尽管多因素分析中未观察到统计学上显著的危险因素。
使用DB-ERC进行内镜球囊扩张治疗良性HJAS有效且安全，近期技术成功率高且不良事件少。需要对该手术进行进一步改进以预防复发性HJAS。
