Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Bologna, Italy.
Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy.
J Gastrointestin Liver Dis. 2019 Mar;28(1):125-128. doi: 10.15403/jgld.2014.1121.281.eus.
We present five cases of pylorus-preserving pancreaticoduodenectomy (PPPD) after endoscopic ultrasonography-guided choledochoduodenostomy (EUS-CD) using a lumen-apposing metal stent (LAMS) as a bridge to surgery in patients with resectable distal malignant biliary obstruction and failed endoscopic retrograde cholangiopancreatography (ERCP). The patients underwent an EUS-CD using EC-LAMS, the bile duct being accessed using the transbulbar approach. The technical success rate of EUS-CD was 100%. No procedure-related adverse events occurred. All patients underwent PPPD with a technical success rate of 100%. The presence of a transduodenal LAMS did not impede surgery. No biliary or duodenal fistula occurred in the patients. Pancreatic fistulas with late bleeding were observed in two patients (one fatal). These few cases indicate that PPPD after EUS-CD using LAMS is feasible and safe. EUS-CD should be performed irrespective of the stage of the disease, also for patients fit for surgery. Additional larger prospective studies are required to confirm this preliminary data, in particular for possible interference with postoperative outcomes.
我们介绍了 5 例经内镜超声引导下胆肠吻合术（EUS-CD）后行保留幽门的胰十二指肠切除术（PPPD）的病例，这些患者因可切除的远端恶性胆道梗阻和内镜逆行胰胆管造影术（ERCP）失败，采用了经内镜超声引导下胆管内置入金属支架（LAMS）作为手术桥梁。患者采用 EC-LAMS 行 EUS-CD，经经皮球囊胆管进入胆管。EUS-CD 的技术成功率为 100%。无手术相关不良事件发生。所有患者均行 PPPD，技术成功率为 100%。十二指肠内置入的 LAMS 不影响手术。患者均未发生胆漏或十二指肠瘘。2 例（1 例致命）患者出现迟发性出血性胰瘘。这些少数病例表明，EUS-CD 联合 LAMS 行 PPPD 是可行且安全的。EUS-CD 应不论疾病分期均应进行，也适用于适合手术的患者。需要进一步开展更大规模的前瞻性研究来证实这初步数据，特别是对于术后结局可能存在的干扰。
