Ardengh José Celso, Lopes César Vivian, Kemp Rafael, Dos Santos José Sebastião
Division of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo 14049-900, Brazil.
Department of Gastroenterology and Digestive Endoscopy, Santa Casa Hospital, Porto Alegre 91410-000, Brazil.
World J Gastrointest Endosc. 2018 May 16;10(5):99-108. doi: 10.4253/wjge.v10.i5.99.
To investigate the success rates of endosonography (EUS)-guided biliary drainage (EUS-BD) techniques after endoscopic retrograde cholangiopancreatography (ERCP) failure for management of biliary obstruction.
From Feb/2010 to Dec/2016, ERCP was performed in 3538 patients, 24 of whom (0.68%) suffered failure to cannulate the biliary tree. All of these patients were initially submitted to EUS-guided rendez-vous (EUS-RV) by means of a transhepatic approach. In case of failure, the next approach was an EUS-guided anterograde stent insertion (EUS-ASI) or an EUS-guided hepaticogastrostomy (EUS-HG). If a transhepatic approach was not possible or a guidewire could not be passed through the papilla, EUS-guided choledochoduodenostomy (EUS-CD) was performed.
Patients were submitted to EUS-RV (7), EUS-ASI (5), EUS-HG (6), and EUS-CD (6). Success rates did not differ among the various EUS-BD techniques. Overall, technical and clinical success rates were 83.3% and 75%, respectively. Technical success for each technique was, 71.4%, 100%, 83.3%, and 83.3%, respectively ( = 0.81). Complications occurred in 3 (12.5%) patients. All of these cases were managed conservatively, but one patient died after rescue percutaneous transhepatic biliary drainage (PTBD).
The choice of a particular EUS-BD technique should be based on patient's anatomy and on whether the guidewire could be passed through the duodenal papilla.
探讨内镜逆行胰胆管造影（ERCP）失败后，内镜超声（EUS）引导下胆道引流（EUS-BD）技术治疗胆道梗阻的成功率。
2010年2月至2016年12月，对3538例患者进行ERCP，其中24例（0.68%）胆管插管失败。所有这些患者最初均采用经肝途径行EUS引导下会师术（EUS-RV）。若失败，则下一步采用EUS引导下顺行支架置入术（EUS-ASI）或EUS引导下肝胃吻合术（EUS-HG）。若无法行经肝途径或导丝无法通过乳头，则行EUS引导下胆总管十二指肠吻合术（EUS-CD）。
患者接受了EUS-RV（7例）、EUS-ASI（5例）、EUS-HG（6例）和EUS-CD（6例）。不同EUS-BD技术的成功率无差异。总体而言，技术成功率和临床成功率分别为83.3%和75%。每种技术的技术成功率分别为71.4%、100%、83.3%和83.3%（ = 0.81）。3例（12.5%）患者发生并发症。所有这些病例均保守治疗，但1例患者在抢救性经皮经肝胆道引流（PTBD）后死亡。
特定EUS-BD技术的选择应基于患者的解剖结构以及导丝是否能够通过十二指肠乳头。
