一种新型电灼增强式递送系统，用于一步法内镜超声引导下使用胆管腔内置入型金属支架进行胆囊和胆管引流：一项可行性研究。
A novel electrocautery-enhanced delivery system for one-step endoscopic ultrasound-guided drainage of the gallbladder and bile duct using a lumen-apposing metal stent: a feasibility study.
机构信息
Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, Republic of Korea.
Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Cheonan, Republic of Korea.
出版信息
Endoscopy. 2021 Sep;53(9):922-926. doi: 10.1055/a-1301-1526. Epub 2020 Dec 17.
BACKGROUND
The use of a lumen-apposing metal stent (LAMS) capable of one-step endoscopic ultrasound-guided transmural drainage (EUS-TD) can increase the effectiveness of the procedure. We evaluated the newly developed electrocautery-enhanced (EC) delivery system with a LAMS for one-step EUS-guided gallbladder drainage (EUS-GBD) or choledochoduodenostomy (EUS-CDS).
METHODS
In the animal experiment, an EC-LAMS was advanced into the gallbladder without prior tract dilation in four pigs. A conventional LAMS was inserted in another four pigs as a control group. After the animal experiment, 17 patients underwent EUS-TD using the EC-LAMS (EUS-GBD in 10 patients, EUS-CDS in 7). The primary outcome was the technical success rate.
RESULTS
In the animal study, the mean procedure time was significantly shorter in the EC-LAMS group than in the conventional LAMS group. In the human study, the overall technical success rate was 94.1 %, with one EUS-GBD failure. The clinical success rate was 100 %. The overall adverse event rate was 17.6 %.
CONCLUSIONS
One-step EUS-GBD or EUS-CDS using the novel EC-LAMS is a feasible approach that achieves a high success rate and maintains safety.
背景
使用能够一步完成内镜超声引导经壁引流（EUS-TD）的通道保持金属支架（LAMS）可以提高手术的效果。我们评估了新开发的电烧增强（EC）输送系统与 LAMS 一起用于一步 EUS 引导胆囊引流（EUS-GBD）或胆肠吻合术（EUS-CDS）。
方法
在动物实验中，在没有事先进行管腔扩张的情况下，将 EC-LAMS 推进到四只猪的胆囊中。另四只猪插入常规 LAMS 作为对照组。动物实验后，17 名患者接受了使用 EC-LAMS 的 EUS-TD（10 名患者行 EUS-GBD，7 名患者行 EUS-CDS）。主要结局是技术成功率。
结果
在动物研究中，EC-LAMS 组的平均手术时间明显短于常规 LAMS 组。在人类研究中，整体技术成功率为 94.1%，1 例 EUS-GBD 失败。临床成功率为 100%。总不良事件发生率为 17.6%。
结论
使用新型 EC-LAMS 的一步 EUS-GBD 或 EUS-CDS 是一种可行的方法，可实现高成功率并保持安全性。
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