service d'Hépato-gastro-entérologie, CHU Dupuytren, Limoges, France.
service d'Hépato-gastro-entérologie, CH Jacques Lacarin, Vichy, France.
Gastrointest Endosc. 2020 Jul;92(1):134-141. doi: 10.1016/j.gie.2020.01.055. Epub 2020 Feb 19.
EUS-guided biliary drainage is indicated in cases of impossibility or failure of classic biliary drainage by ERCP. Recently we reported good efficiency of EUS-guided choledochoduodenostomy (EUS-CDS) using the electrocautery-enhanced lumen-apposing metal stent (ECE-LAMS) in a retrospective multicenter study. Use of the recommended technique (direct puncture with the ECE-LAMS with use of a pure cut current and a 6-mm stent) was the only predictive factor of clinical success. We re-evaluated this procedure after 1 year in the same centers.
This was a French retrospective multicenter study of a prospective database including all cases of EUS-guided CDS with ECE-LAMS in the 7 centers that participated in the first study.
Seventy consecutive patients were included in this study between September 1, 2017, and September 22, 2018. Failure of primary ERCP was due to duodenal stenosis in 44% of cases and to tumoral infiltration of the papilla in 22% of cases. The mean duration of the procedure was 5 ± 3 minutes. The recommended technique was used in 98.5% of cases. The technical and clinical success rates were both 97.1% (69/70). Short-term adverse events (periprocedural and intrahospital) occurred in 1.6%.
EUS-CDS with the ECE-LAMS is efficacious and safe in distal malignant obstruction of the common bile duct in cases of ERCP failure with impressive results once expertise is acquired and the recommended technique (direct fistulotomy, pure cut current, and 6-mm stent) is followed.
在经内镜逆行胰胆管造影（ERCP）无法或失败的情况下，超声内镜（EUS）引导下胆道引流术是一种适应证。最近，我们在一项回顾性多中心研究中报告了使用电烧增强型 lumen-apposing 金属支架（ECE-LAMS）行 EUS 引导下胆肠吻合术（EUS-CDS）的良好效果。只有推荐技术（使用 ECE-LAMS 进行直接穿刺，使用纯切割电流和 6mm 支架）的使用是临床成功的唯一预测因素。我们在同一中心对该技术进行了为期 1 年的重新评估。
这是一项法国回顾性多中心研究，对参与第一项研究的 7 个中心的前瞻性数据库中的所有 EUS 引导下 CDS 患者进行了研究。
2017 年 9 月 1 日至 2018 年 9 月 22 日，本研究共纳入 70 例连续患者。初次 ERCP 失败的原因包括 44%的十二指肠狭窄和 22%的乳头肿瘤浸润。手术平均时间为 5±3 分钟。推荐技术的使用率为 98.5%。技术成功率和临床成功率均为 97.1%（69/70）。短期不良事件（围手术期和院内）发生率为 1.6%。
在 ERCP 失败的情况下，对于远端恶性胆总管阻塞，使用 ECE-LAMS 的 EUS-CDS 是有效且安全的，一旦掌握了技术并遵循推荐的技术（直接吻合切开术、纯切割电流和 6mm 支架），则效果显著。
