Kanno Yoshihide, Koshita Shinsuke, Ogawa Takahisa, Masu Kaori, Kusunose Hiroaki, Sakai Toshitaka, Murabayashi Toji, Hasegawa Sho, Kozakai Fumisato, Yonamine Keisuke, Kawakami Yujiro, Fujii Yuki, Horaguchi Jun, Noda Yutaka, Ito Kei
Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai, Miyagi, Japan.
Natori Chuo Clinic, 8, Masuda-Yanagida, Natori, Miyagi, Japan.
J Gastrointest Cancer. 2019 Sep;50(3):469-477. doi: 10.1007/s12029-018-0096-1.
To evaluate clinical outcomes of endoscopic ultrasound (EUS)-guided biliary drainage (EUS-BD) for unresectable malignant biliary obstruction for cases in which endoscopic retrograde cholangiopancreatography (ERCP) failed at a high-volume center.
All 99 EUS-BD cases of unresectable malignant biliary obstruction at Sendai City Medical Center between February 2007 and September 2017 were retrospectively evaluated. ERCP is strictly prioritized over EUS-BD during the study period, and EUS-BD was performed in cases wherein ERCP was impossible or ineffective. Technical success, clinical success, adverse events, and time to recurrence of biliary obstruction were evaluated.
EUS-BD was technically successful in 98% of the patients (97/99). The clinical success rate was 93% (90/97). Adverse events that were definitely related to the procedure were observed in ten patients (10%; peritonitis in six, acute cholecystitis in four). Of six patients with bile peritonitis, four suffered from mild localized peritonitis that improved with conservative treatment, whereas two developed pan-peritonitis that improved with additional intervention. Other three patients with a poor performance status succumbed shortly after the successful EUS-BD, with a possible association between the procedure and death. In the 68 patients with a bilioenteric stent, the median time to recurrence of biliary obstruction was 339 days (95% confidence interval (CI), 14-664 days) during the mean follow-up period of 136 ± 173 days.
EUS-BD was found to be feasible. However, there were a few patients with an unfavorable course after successful EUS-BD.
在一家大型医疗中心，评估内镜超声（EUS）引导下胆道引流（EUS-BD）用于内镜逆行胰胆管造影（ERCP）失败的不可切除恶性胆道梗阻病例的临床疗效。
回顾性评估2007年2月至2017年9月在仙台市医疗中心进行的99例不可切除恶性胆道梗阻的EUS-BD病例。在研究期间，ERCP严格优先于EUS-BD，仅在ERCP无法实施或无效的情况下才进行EUS-BD。评估技术成功率、临床成功率、不良事件以及胆道梗阻复发时间。
98%的患者（97/99）EUS-BD技术成功。临床成功率为93%（90/97）。10例患者（10%）出现与操作明确相关的不良事件（6例腹膜炎，4例急性胆囊炎）。6例胆汁性腹膜炎患者中，4例为轻度局限性腹膜炎，经保守治疗好转，2例发展为全腹膜炎，经额外干预后好转。另外3例身体状况较差的患者在EUS-BD成功后不久死亡，死亡可能与操作有关。在68例置入胆肠支架的患者中，在平均136±173天的随访期内，胆道梗阻复发的中位时间为339天（95%置信区间（CI），14 - 664天）。
EUS-BD是可行的。然而，有少数患者在EUS-BD成功后病程不佳。
