Department of Surgery, The University of Hong Kong, Hong Kong.
Division of Gastroenterology, Department of Internal Medicine, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea.
J Gastroenterol Hepatol. 2020 Oct;35(10):1753-1760. doi: 10.1111/jgh.15089. Epub 2020 May 17.
Segregated right intrahepatic duct dilatation (IHD) results from complete obstruction of the biliary tract proximal to the hilar level. We aimed to evaluate long-term efficacy and safety of endoscopic ultrasound (EUS) hepaticoduodenostomy (HDS) in segregated right IHD.
Consecutive patients who had undergone EUS-guided HDS with a fully covered self-expandable metal stent (FCSEMS) in an academic tertiary center were recruited. All patients had segregated right hepatic duct and failed drainage by endoscopic retrograde cholangiopancreatography (ERCP). Demographic data, endoscopic findings, procedure details, and outcome data were extracted from a prospectively maintained database.
From 2013 to 2017, there were 35 patients who had undergone EUS-guided HDS with a median follow-up duration of 169 (3-2091) days. Malignancy accounted for 71.4% of the ductal segregation, followed by surgical complication (17.1%). Technical and clinical success rate was 97.1% and 80%, respectively. Early adverse event (AE) happened in seven patients (20%), two of them required endoscopic reintervention, and no percutaneous transhepatic biliary drainage (PTBD) or surgery was performed because of AE. The median stent patency duration was 331 (3-1202) days. The median duration of fistula tract keeping was 1280 (3-1280) days. There was no significant difference in terms of patency rate with respect to whether the underlying pathology was benign or malignant (P = 0.776). EUS-guided HDS for right posterior sectional duct segregation was associated with higher 3-month stent patency rate when compared with right anterior sectional duct (79.1% vs 38.1%, P = 0.012).
Endoscopic ultrasound-guided HDS with an FCSEMS appears to be a safe and effective treatment as a viable alternative option to PTBD after failed ERCP. It creates a durable and reliable fistula tract for permanent access to an isolated ductal system, and this application deserves more attention.
孤立性右肝内胆管扩张（IHD）是由于肝门水平近端胆道完全阻塞所致。我们旨在评估内镜超声（EUS）肝十二指肠吻合术（HDS）治疗孤立性右 IHD 的长期疗效和安全性。
在学术性三级中心，连续入组接受 EUS 引导下完全覆膜自膨式金属支架（FCSEMS）HDS 的患者。所有患者均有孤立性右肝管且内镜逆行胰胆管造影（ERCP）引流失败。从一个前瞻性维护的数据库中提取人口统计学数据、内镜发现、操作细节和结果数据。
2013 年至 2017 年，有 35 例患者接受了 EUS 引导下 HDS，中位随访时间为 169（3-2091）天。胆管分离的主要原因为恶性肿瘤（71.4%），其次为手术并发症（17.1%）。技术成功率和临床成功率分别为 97.1%和 80%。7 例（20%）患者发生早期不良事件（AE），其中 2 例需要内镜再介入治疗，由于 AE 未行经皮经肝胆管引流（PTBD）或手术。中位支架通畅时间为 331（3-1202）天。瘘管保持时间的中位数为 1280（3-1280）天。基础病变为良性或恶性时，通畅率无显著差异（P=0.776）。与右前节段胆管分离相比，EUS 引导下 HDS 治疗右后节段胆管分离具有更高的 3 个月支架通畅率（79.1% vs 38.1%，P=0.012）。
EUS 引导下 FCSEMS 肝十二指肠吻合术似乎是一种安全有效的治疗方法，是 ERCP 失败后 PTBD 的可行替代方案。它为孤立胆管系统提供了一个持久可靠的瘘管通道，这种应用值得更多关注。
