Pizzicannella Margherita, Caillol Fabrice, Pesenti Christian, Bories Erwan, Ratone Jean Philippe, Giovannini Marc
Endoscopy Unit, Campus Bio-Medico University of Rome, Rome, Italy.
Endoscopy Unit, Paoli Calmettes Institute, Marseille, France.
Endosc Ultrasound. 2020 Jan-Feb;9(1):45-52. doi: 10.4103/eus.eus_55_19.
The management of benign biliary stricture in patients with altered anatomy secondary to surgery is challenging. Percutaneous transhepatic biliary drainage (BD) represents the standard therapy for benign biliary stricture, but it is associated with nontrivial morbidity rates. Despite the increasing application of guided BD (EUS-BD) for the management of malignant obstruction, its role in patients with benign biliary stricture is limited. This retrospective study aimed to evaluate the feasibility, safety, and clinical effectiveness of EUS-BD with multiple transanastomotic plastic stent treatment in patients with benign biliary stricture.
This study included consecutive patients who underwent EUS-BD for benign biliary stenosis at our center. EUS-BD with fully covered self-expandable metal stent placement was performed first. When feasible, the stricture was treated by balloon dilation with the placement of a transanastomotic double-pigtail plastic stent. Scheduled procedures were repeated to remove the metal stent and replace the plastic stent to treat the stenosis. Technical success and adverse events (AEs) were assessed.
Twelve patients underwent EUS-BD for benign biliary strictures. Procedural and clinical successes were achieved in all patients (100%). Multistenting treatment was performed in 10/12 patients (77%). The median number of stents inserted, maximum number of stents placed, and median time of retreatment were 2.4 (range: 1-4), 4, and 3.4 (range: 1-7), respectively. In total, 4/12 patients (33.3%) developed AEs that required endoscopic interventions (Clavien-Dindo Grade III).
EUS-BD with the placement of multiple trans-stenosis plastic stents is a safe, feasible, and well-tolerated alternative for the management of benign biliary stricture in patients with surgery-altered anatomy. Long-term follow-up is necessary to support our results.
手术导致解剖结构改变的患者中，良性胆管狭窄的管理具有挑战性。经皮经肝胆道引流（BD）是良性胆管狭窄的标准治疗方法，但它与相当高的发病率相关。尽管内镜超声引导下胆管引流（EUS-BD）在恶性梗阻管理中的应用日益增加，但其在良性胆管狭窄患者中的作用有限。这项回顾性研究旨在评估EUS-BD联合多根经吻合口塑料支架治疗良性胆管狭窄患者的可行性、安全性和临床有效性。
本研究纳入了在我们中心接受EUS-BD治疗良性胆管狭窄的连续患者。首先进行带全覆膜自膨式金属支架置入的EUS-BD。若可行，通过球囊扩张并置入经吻合口双猪尾塑料支架来治疗狭窄。定期重复操作以取出金属支架并更换塑料支架来治疗狭窄。评估技术成功率和不良事件（AE）。
12例患者接受了EUS-BD治疗良性胆管狭窄。所有患者均获得了操作成功和临床成功（100%）。10/12例患者（77%）进行了多支架治疗。置入支架的中位数、置入支架的最大数量和再次治疗的中位时间分别为2.4（范围：1 - 4）、4和3.4（范围：1 - 7）。总共4/12例患者（33.3%）发生了需要内镜干预的AE（Clavien-Dindo III级）。
EUS-BD联合置入多根跨狭窄塑料支架是手术导致解剖结构改变的良性胆管狭窄患者管理的一种安全、可行且耐受性良好的替代方法。需要长期随访以支持我们的结果。
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