Maehara Kosuke, Hijioka Susumu, Nagashio Yoshikuni, Ohba Akihiro, Maruki Yuta, Suzuki Hiromi, Sone Miyuki, Okusaka Takuji, Saito Yutaka
Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan.
Department of Radiological Technology, National Cancer Center Hospital, Tokyo, Japan.
Endosc Int Open. 2020 Aug;8(8):E1034-E1038. doi: 10.1055/a-1169-3749. Epub 2020 Jul 21.
Use of endoscopic ultrasound-guided biliary drainage (EUS-BD) has recently increased. In EUS-BD, after puncturing the bile duct, dilation is performed and the stent is deployed. Due to adverse events (AEs) such as unexpected displacement of the guidewire, simplified procedures are required. Currently, stents with small-diameter delivery systems are being rapidly developed, expanding the possibilities for of EUS-BD without dilation. In this retrospective study, we aimed to evaluate the success rates and AEs in patients who underwent EUS-guided hepaticogastrostomy (EUS-HGS) or EUS-guided hepaticojejunostomy (EUS-HJS) without dilation. Six consecutive patients with malignant biliary obstruction and failed transpapillary BD underwent EUS-HGS or EUS-HJS without dilation, deploying a 6-mm fully-covered self-expandable metallic stent with a 6-Fr delivery system. The technical and clinical success rates were 100 %. There was one case each of stent migration and stent occlusion, and no other AEs were noted. EUS-HGS or EUS-HJS without dilation using a stent with a 6-Fr delivery system had high technical and clinical success rates; however, additional cases are required to validate the study findings.
内镜超声引导下胆道引流术（EUS-BD）的应用近来有所增加。在EUS-BD中，穿刺胆管后进行扩张并置入支架。由于存在导丝意外移位等不良事件（AE），需要简化操作程序。目前，小直径输送系统的支架正在迅速发展，扩大了不进行扩张的EUS-BD的可能性。在这项回顾性研究中，我们旨在评估未进行扩张的接受内镜超声引导下肝胃吻合术（EUS-HGS）或内镜超声引导下肝空肠吻合术（EUS-HJS）患者的成功率和不良事件。连续6例恶性胆管梗阻且经乳头胆管引流失败的患者接受了未扩张的EUS-HGS或EUS-HJS，使用6F输送系统置入6毫米全覆膜自膨式金属支架。技术成功率和临床成功率均为100%。各有1例支架移位和支架闭塞，未发现其他不良事件。使用6F输送系统的支架进行未扩张的EUS-HGS或EUS-HJS具有较高的技术成功率和临床成功率；然而，需要更多病例来验证研究结果。
