Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States.
Division of Gastroenterology and Hepatology, Virginia Mason, Seattle, Washington, United States.
Endoscopy. 2018 Sep;50(9):891-895. doi: 10.1055/s-0044-102254. Epub 2018 Mar 2.
Afferent loop syndrome (ALS) is traditionally managed surgically and, more recently, endoscopically. The role of endoscopic ultrasound-guided entero-enterostomy (EUS-EE) has not been well described. The aim of this study was to assess the technical and clinical success and safety of EUS-EE.
This was a multicenter, retrospective series at six centers in patients with ALS treated by EUS-EE. Data on patients treated with enteroscopy-assisted luminal stenting (EALS) at a single center were also collected.
18 patients (mean age 64.2 years, 72 % post-pancreaticoduodenectomy, 10 female) underwent EUS-EE. The most common symptoms were vomiting (27.8 %) and jaundice (33.3 %). Clinical success included resolution of symptoms in 88.9 % and improvement to allow hospital discharge in 11.1 %. Technical success was achieved in 100 % of cases, with a mean procedure time of 29.7 minutes. The most common procedure was a gastro-jejunostomy (72.2 %). Three adverse events (16.7 %) occurred (two mild, one moderate). When compared with data on EALS, patients treated with EUS-EE needed fewer re-interventions (16.6 % vs. 76.5 %; < 0.001).
EUS-EE seems to be safe and effective in the treatment of ALS. Indirect comparison with EALS suggested that EUS-EE is associated with a reduced need for re-intervention.
输入袢综合征（ALS）传统上通过手术治疗，最近也通过内镜治疗。内镜超声引导内肠内吻合术（EUS-EE）的作用尚未得到很好的描述。本研究旨在评估 EUS-EE 的技术和临床成功率及安全性。
这是一项在六个中心进行的多中心回顾性研究，纳入了接受 EUS-EE 治疗的 ALS 患者。还收集了一家中心采用内镜辅助腔内支架置入术（EALS）治疗的患者的数据。
18 例患者（平均年龄 64.2 岁，72%为胰十二指肠切除术后，10 例女性）接受了 EUS-EE。最常见的症状是呕吐（27.8%）和黄疸（33.3%）。临床成功率包括 88.9%的症状缓解和 11.1%的可允许出院的改善。技术成功率为 100%，平均手术时间为 29.7 分钟。最常见的手术是胃空肠吻合术（72.2%）。发生了 3 例不良事件（16.7%）（2 例轻度，1 例中度）。与 EALS 数据相比，接受 EUS-EE 治疗的患者需要的再干预较少（16.6% vs. 76.5%；<0.001）。
EUS-EE 似乎是治疗 ALS 的安全有效的方法。与 EALS 的间接比较表明，EUS-EE 与减少再干预的需求相关。
