Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
Third Department of Surgery, Tokyo Medical University, Tokyo, Japan.
Gastrointest Endosc. 2019 Feb;89(2):399-407. doi: 10.1016/j.gie.2018.07.030. Epub 2018 Aug 1.
Although balloon enteroscopy-assisted ERCP (BE-ERCP) is effective and safe for benign biliary diseases in patients with surgically altered anatomy (SAA), BE-ERCP is not always successful. Recently, EUS-guided antegrade intervention (EUS-AI) by using a 1-stage or 2-stage procedure has been developed for BE-ERCP failure cases. The aim of the present study was to evaluate the outcome of EUS-AI for benign biliary diseases in patients with SAA.
Of 48 patients in whom BE-ERCP failed, percutaneous transhepatic intervention was performed in 11. From November 2013 until November 2017, we retrospectively reviewed cases of an additional 37 patients with SAA who failed BE-ERCP and underwent EUS-AI for benign biliary diseases (common bile duct stones [n = 11], intrahepatic bile duct stones [n = 5], anastomotic strictures [n = 21]).
The overall technical success of the creation of the hepatoenteric tract by EUS was 91.9% (34/37). Moderate adverse events were observed in 8.1% (biliary peritonitis [n = 3]). One-stage EUS-AI by EUS succeeded in 8 cases (100%) without any adverse events. In another 26 cases, 2-stage EUS-AI by ERCP was performed about 1 or 2 months later. Endoscopic antegrade therapy under fluoroscopy was successful in 6 cases. Per-oral cholangioscopy-assisted antegrade intervention was required in 19 cases (guidewire manipulation across the anastomotic stricture [n = 6], cholangioscopy-guided lithotripsy by using electrohydraulic lithotripsy [n = 13]). In 1 case, magnetic compression anastomosis was performed. The final clinical success rate of all EUS-AIs was 91.9%.
EUS-AI for benign biliary diseases in patients with SAA appears to be a feasible and safe alternative procedure after BE-ERCP failure.
虽然经气囊辅助小肠镜逆行胰胆管造影术（BE-ERCP）对伴有手术改变解剖结构（SAA）的良性胆道疾病是有效且安全的，但 BE-ERCP 并不总是成功的。最近，经超声内镜引导的顺行介入（EUS-AI）已通过 1 期或 2 期手术用于 BE-ERCP 失败的病例。本研究的目的是评估 EUS-AI 治疗伴有 SAA 的良性胆道疾病的结果。
在 48 例 BE-ERCP 失败的患者中，有 11 例患者行经皮经肝胆道介入治疗。从 2013 年 11 月至 2017 年 11 月，我们回顾性分析了 37 例伴有 SAA 的 BE-ERCP 失败的患者，这些患者因良性胆道疾病（胆总管结石[n=11]、肝内胆管结石[n=5]、吻合口狭窄[n=21]）接受了 EUS-AI 治疗。
EUS 建立肝肠通道的总体技术成功率为 91.9%（34/37）。8.1%（3 例胆汁性腹膜炎）出现中度不良事件。8 例（100%）患者成功实施 1 期 EUS-AI，无任何不良事件。在另外 26 例患者中，约 1 或 2 个月后进行了 2 期 ERCP-EUS-AI。透视下经内镜逆行胰胆管造影术成功完成 6 例。需要进行经口胆管镜辅助逆行介入治疗的有 19 例（吻合口狭窄导丝操作[n=6]、电液压碎石术引导下胆管镜碎石术[n=13]）。1 例患者进行了磁压迫吻合术。所有 EUS-AI 的最终临床成功率为 91.9%。
EUS-AI 治疗伴有 SAA 的良性胆道疾病似乎是 BE-ERCP 失败后的一种可行且安全的替代方法。
