2nd Department of Internal Medicine, Osaka Medical College, 2-7 Daigakuchou, Takatsukishi, Osaka, 569-8686, Japan.
J Gastrointest Surg. 2018 Jul;22(7):1309-1311. doi: 10.1007/s11605-018-3719-8. Epub 2018 Apr 26.
Endoscopic ultrasound-guided hepaticojejunostomy (EUS-HJS) combined with antegrade stenting (AS) can proceed if patients are complicated with duodenal obstruction or surgical anatomy such as Roux-en-Y esophagojejunostomy. A novel plastic stent (Gadelius Medical Co. Ltd., Tokyo, Japan) that is designed to prevent stent migration into the abdominal cavity was made available in Japan. Here, we describe technical tips for EUS-HJS combined with EUS-AS using this plastic stent.
After the intrahepatic bile duct is punctured, the guidewire is inserted into the intestine across the bile duct obstruction site. Next, the fistula is dilated using a balloon catheter. And then, metal stent placement is antegradely performed. Finally, stent placement using this novel plastic stent is performed from the intrahepatic bile duct to the intestine.
Compared with EUS-HJS using a metal stent, EUS-HJS using this novel plastic stent has several advantages such as cost benefit, easy re-intervention, and preventing vomiting due to reflux bile juice. Therefore, EUS-HJS combined with AS using this novel plastic stent may be preferable compared with using a metal stent.
如果患者存在十二指肠梗阻或 Roux-en-Y 肠胆吻合等手术解剖结构等问题，可进行内镜超声引导下肝肠吻合术（EUS-HJS）联合顺行支架置入术（AS）。日本开发了一种新型塑料支架（Gadelius Medical Co. Ltd.，东京，日本），旨在防止支架迁移到腹腔。在此，我们介绍使用这种塑料支架进行 EUS-HJS 联合 EUS-AS 的技术要点。
在经肝内胆管穿刺后，将导丝穿过胆管梗阻部位插入肠道。然后，使用球囊导管扩张瘘管。接着，进行金属支架的顺行放置。最后，从肝内胆管向肠道进行新型塑料支架的放置。
与使用金属支架的 EUS-HJS 相比，使用这种新型塑料支架的 EUS-HJS 具有成本效益高、易于再次介入和防止反流胆汁引起呕吐等优点。因此，与使用金属支架相比，使用这种新型塑料支架进行 EUS-HJS 联合 AS 可能更可取。
