Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Gastrointest Endosc. 2020 Sep;92(3):623-631.e1. doi: 10.1016/j.gie.2020.03.3856. Epub 2020 Apr 9.
We previously reported safety and effectiveness of EUS-guided hepaticogastrostomy (EUS-HGS) using a long, partially covered metal stent (LP-CMS) for malignant biliary obstruction (MBO). In this study, we aimed to evaluate long-term outcomes of EUS-HGS in an expanded cohort.
One hundred ten patients undergoing EUS-HGS using an LP-CMS in 2 centers were retrospectively studied. Technical and functional success, adverse events, recurrent biliary obstruction (RBO), and reinterventions were evaluated.
The cause of MBO was pancreatic cancer in 50%, and the location of MBO was distal in 68%. The stent length was 8 cm in 2%, 10 cm in 84%, and 12 cm in 15%, with a median intragastric stent length of 54 mm. Technical and functional success rates were 100% and 94%, respectively. The adverse event rate was 25% (mild 15%, moderate 7%, severe 3%), but about one-half of adverse events were mild transient fever and abdominal pain. RBO developed in 33%, with a median cumulative time to RBO of 6.3 months. The major cause of RBO was hyperplasia at an uncovered portion. The presence of prior biliary drainage and short intragastric stent length were significantly associated with RBO. Reintervention for RBO was successfully achieved through the EUS-HGS route in 92%. The remaining reintervention procedures were 1 EUS-HGS and 2 percutaneous transhepatic biliary drainage all in cases with hilar MBO.
EUS-HGS using an LP-CMS for unresectable MBO was safe and effective. RBO was not uncommon, but reintervention through the EUS-HGS route was technically possible in most cases.
我们之前报道了使用长型部分覆盖金属支架（LP-CMS）进行超声内镜引导下肝胃吻合术（EUS-HGS）治疗恶性胆道梗阻（MBO）的安全性和有效性。在这项研究中，我们旨在扩大队列评估 EUS-HGS 的长期结果。
回顾性研究了在 2 个中心接受 EUS-HGS 治疗的 110 例患者，使用 LP-CMS。评估了技术和功能成功率、不良事件、复发性胆道梗阻（RBO）和再介入治疗。
MBO 的病因是胰腺癌占 50%，MBO 的位置是远端占 68%。支架长度为 2%的 8cm、84%的 10cm 和 15%的 12cm，胃内支架的中位长度为 54mm。技术和功能成功率分别为 100%和 94%。不良事件发生率为 25%（轻度 15%，中度 7%，重度 3%），但约一半的不良事件是轻度短暂发热和腹痛。RBO 的发生率为 33%，RBO 的中位累积时间为 6.3 个月。RBO 的主要原因是未覆盖部分的增生。先前存在胆道引流和胃内支架短是 RBO 的显著相关因素。通过 EUS-HGS 途径成功治疗 RBO 占 92%。其余的再介入治疗程序是 1 次 EUS-HGS 和 2 次经皮经肝胆管引流术，均用于肝门 MBO 病例。
对于不可切除的 MBO，使用 LP-CMS 的 EUS-HGS 是安全有效的。RBO 并不少见，但大多数情况下通过 EUS-HGS 途径进行再介入治疗在技术上是可行的。
