Ogura Takeshi, Takenaka Mamoru, Shiomi Hideyuki, Goto Daisuke, Tamura Takashi, Hisa Takeshi, Kato Hironari, Nishioka Nobu, Minaga Kosuke, Masuda Atsuhiro, Onoyama Takumi, Kudo Masatoshi, Higuchi Kazuhide, Kitano Masayuki
Therapeutic Endoscopic Ultrasound Group: TEUS; 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
Therapeutic Endoscopic Ultrasound Group: TEUS; Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan.
Endosc Ultrasound. 2019 Nov-Dec;8(6):398-403. doi: 10.4103/eus.eus_45_19.
Biliary drainage (BD) under EUS guidance is usually indicated for malignant biliary obstruction. Recently, EUS-guided transluminal treatment has been applied to benign biliary disease (BBD). This multicenter retrospective study evaluated the clinical impact of EUS-guided transluminal stent deployment for BBD with long-term follow-up.
This retrospective study investigated patients treated between September 2015 and October 2016 at participating hospitals in the therapeutic endoscopic group. The inclusion criteria comprised complications with BBD obstructive jaundice or cholangitis and failed endoscopic retrograde cholangiopancreatography or inaccessible ampulla of Vater.
Twenty-six patients underwent EUS-guided transluminal stent deployment. Indications for EUS-guided transluminal stent deployment comprised anastomotic biliary stricture (n = 17), bile duct stones (n = 5), inflammatory biliary stricture (n = 3), and acute pancreatitis prevention (n = 1). Thirteen of these 26 patients underwent scheduled reintervention, with technical success achieved in all 13 patients. None of the deployed stents became dysfunctional. Among the 13 patients who underwent reintervention on demand, stents had become dysfunctional in six patients (stent patency: 48, 90, 172, 288, 289, and 608 days). Reintervention was successfully performed in all patients. During follow-up (median, 749 days), severe adverse events were not seen in any patients.
We concluded that EUS-guided transluminal stent deployment for BBD is feasible and safe. Because metal stent dysfunction was more frequent when deployed on demand, such stents should be exchanged for plastic stents in a scheduled manner if a metal stent is used.
内镜超声引导下胆道引流（BD）通常用于恶性胆道梗阻。近来，内镜超声引导下腔内治疗已应用于良性胆道疾病（BBD）。这项多中心回顾性研究通过长期随访评估了内镜超声引导下腔内支架置入术对BBD的临床影响。
这项回顾性研究调查了2015年9月至2016年10月期间在治疗性内镜组参与医院接受治疗的患者。纳入标准包括BBD梗阻性黄疸或胆管炎并发症、内镜逆行胰胆管造影失败或无法到达的 Vater壶腹。
26例患者接受了内镜超声引导下腔内支架置入术。内镜超声引导下腔内支架置入术的适应证包括吻合口胆管狭窄（n = 17）、胆管结石（n = 5）、炎性胆管狭窄（n = 3）和预防急性胰腺炎（n = 1）。这26例患者中有13例接受了计划性再次干预，所有13例患者均取得技术成功。所有置入的支架均未出现功能障碍。在13例按需进行再次干预的患者中，6例患者的支架出现功能障碍（支架通畅时间分别为48、90、172、288、289和608天）。所有患者再次干预均成功进行。在随访期间（中位时间749天），未观察到任何患者出现严重不良事件。
我们得出结论，内镜超声引导下腔内支架置入术治疗BBD是可行且安全的。由于按需置入金属支架时功能障碍更为常见，如果使用金属支架，应定期将此类支架更换为塑料支架。
