Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan.
Division of Genetic Medicine Promotion, Shizuoka Cancer Center, Shizuoka, Japan.
Surg Endosc. 2021 Dec;35(12):6836-6845. doi: 10.1007/s00464-020-08189-w. Epub 2021 Jan 4.
In endoscopic retrograde cholangiopancreatography (ERCP), reduction of pressure inside of the bile duct by bile aspiration is a well-known method to lower the rate of adverse events (AEs) including cholangitis. Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) has been introduced as an alternative to ERCP. The use of self-expandable metallic stents is recommended in EUS-HGS to reduce bile leak; however, other methods to reduce the rate of AEs including bile leak, abdominal pain, fever, and sepsis, have not been elucidated yet. This study investigated whether bile aspiration during EUS-HGS decreased the rate of postprocedural AEs.
Consecutive patients who underwent EUS-HGS between July 2016 and April 2020 were retrospectively evaluated in this study. EUS-HGS was performed at a tertiary cancer center. Patient characteristics, site of biliary obstruction, the quantity of bile aspirated during EUS-HGS, type of stent, whether or not antegrade stenting (AS) was performed, procedure time, and AEs were assessed based on a prospectively recorded institutional endoscopy database. Logistic regression analysis was performed to identify factors affecting postprocedural AEs.
Ninety-six patients were included in the study. EUS-guided HGS with and without AS was performed in 45 and 51 patients, respectively. Bile was aspirated in 71 patients (74%). The quantity of bile aspirated was 0-10 mL and > 10 mL in 40 and 56 patients, respectively. AEs including fever, abdominal pain, postprocedural cholangitis, sepsis, acute pancreatitis, and bleeding occurred in 45 patients (47%). The AE rates were 65% (26/40) and 34% (19/56), for 0-10 mL and > 10 mL bile, respectively (p = 0.004). Using multivariate analysis, the only independent factor affecting the occurrence of AEs was found to be an aspirated bile amount of 0-10 mL (odds ratio: 4.16; 95% CI 1.6-10.8).
Bile aspiration of more than 10 mL during EUS-HGS contributes to reducing the rate of postprocedural AEs.
在经内镜逆行胰胆管造影术（ERCP）中，通过胆汁抽吸来降低胆管内压力是降低包括胆管炎在内的不良事件（AE）发生率的一种众所周知的方法。内镜超声引导下经肝胆管造口术（EUS-HGS）已被引入作为 ERCP 的替代方法。建议在 EUS-HGS 中使用自膨式金属支架以减少胆漏；然而，尚未阐明其他降低包括胆漏、腹痛、发热和败血症在内的 AE 发生率的方法。本研究旨在探讨 EUS-HGS 过程中的胆汁抽吸是否降低了术后不良事件的发生率。
本研究回顾性评估了 2016 年 7 月至 2020 年 4 月期间在一家三级癌症中心接受 EUS-HGS 的连续患者。根据前瞻性记录的机构内镜数据库，评估患者特征、胆道梗阻部位、EUS-HGS 期间抽吸的胆汁量、支架类型、是否进行逆行支架置入术（AS）、手术时间和不良事件。采用 logistic 回归分析来确定影响术后不良事件的因素。
本研究共纳入 96 例患者。分别对 45 例和 51 例患者进行了 EUS 引导下 HGS 术和 EUS 引导下 HGS 术联合 AS。在 71 例患者（74%）中抽吸了胆汁。抽吸的胆汁量为 0-10ml 和>10ml 的患者分别为 40 例和 56 例。45 例（47%）患者发生发热、腹痛、术后胆管炎、败血症、急性胰腺炎和出血等不良事件。0-10ml 胆汁和>10ml 胆汁的 AE 发生率分别为 65%（26/40）和 34%（19/56）（p=0.004）。多因素分析发现，唯一影响 AE 发生的独立因素是抽吸 0-10ml 胆汁（比值比：4.16；95%CI 1.6-10.8）。
EUS-HGS 过程中抽吸超过 10ml 的胆汁有助于降低术后不良事件的发生率。
