2nd Department of Internal Medicine, Osaka Medical College, 2-7 Daigakuchou, Takatsukishi, Osaka, 569-8686, Japan.
J Gastrointest Surg. 2019 Jan;23(1):192-198. doi: 10.1007/s11605-018-3914-7. Epub 2018 Aug 20.
Recently, endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS) combined with antegrade stenting (AS) has been reported to be associated with longer stent patency and reduced procedure-related adverse events. In EUS-AS, an uncovered metal stent is usually selected to prevent stent misplacement or dislocation. However, because patient survival has improved with advances in chemotherapy, longer stent patency may be required.
The technical feasibility and safety of EUS-guided transhepatic biliary drainage combined with EUS-AS using a novel covered metal stent were evaluated.
Patients with malignant biliary obstruction leading to obstructive jaundice, in whom standard ERCP had failed or was contraindicated, were enrolled in this study between July 2015 and October 2017. As the control group, patients undergoing EUS-AS using an uncovered metal stent were enrolled between October 2014 and June 2015.
A total of 39 patients were enrolled in this study. Among them, EUS-AS using a covered metal stent was performed in 17 patients and using an uncovered metal stent in the remaining 22 patients. Median stent patency including stent dysfunction and patient death was longer in the covered metal stent group (153 days) compared with that of the uncovered metal stent group (108 days) although there were no significant differences (P = 0.06). In only cases with stent dysfunction was median stent patency of the covered metal stent group significantly longer than that of the uncovered metal stent group (not available vs 150 days, P = 0.02).
In conclusion, EUS-guided transluminal biliary drainage combined with EUS-AS using a covered metal stent may be feasible and safe, although the indications for this procedure should be carefully considered.
最近，内镜超声（EUS）引导下肝胃吻合术（HGS）联合顺行支架置入术（AS）已被报道与更长的支架通畅率和减少与手术相关的不良事件相关。在 EUS-AS 中，通常选择未覆盖的金属支架以防止支架错位或脱位。然而，由于化疗的进步提高了患者的生存率，因此可能需要更长的支架通畅率。
评估 EUS 引导下经肝胆汁引流联合使用新型覆盖金属支架的 EUS-AS 的技术可行性和安全性。
本研究纳入了 2015 年 7 月至 2017 年 10 月间因恶性胆道梗阻导致阻塞性黄疸且标准 ERCP 失败或禁忌的患者。作为对照组，纳入了 2014 年 10 月至 2015 年 6 月间接受 EUS-AS 联合使用未覆盖金属支架的患者。
共纳入 39 例患者。其中，17 例患者接受了 EUS-AS 联合使用覆盖金属支架，其余 22 例患者接受了 EUS-AS 联合使用未覆盖金属支架。尽管无显著差异（P=0.06），但覆盖金属支架组的中位支架通畅率（包括支架功能障碍和患者死亡）为 153 天，明显长于未覆盖金属支架组的 108 天。仅在支架功能障碍的情况下，覆盖金属支架组的中位支架通畅率明显长于未覆盖金属支架组（无法评估 vs 150 天，P=0.02）。
总之，EUS 引导下经腔道胆道引流联合使用覆盖金属支架的 EUS-AS 可能是可行和安全的，尽管应仔细考虑该手术的适应证。
