超声内镜引导下肝胆管引流术中胆汁抽吸与术后不良事件风险降低相关：一项回顾性单中心研究。
Bile aspiration during EUS-guided hepaticogastrostomy is associated with lower risk of postprocedural adverse events: a retrospective single-center study.
机构信息
Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan.
Division of Genetic Medicine Promotion, Shizuoka Cancer Center, Shizuoka, Japan.
出版信息
Surg Endosc. 2021 Dec;35(12):6836-6845. doi: 10.1007/s00464-020-08189-w. Epub 2021 Jan 4.
BACKGROUND
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.
METHODS
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.
RESULTS
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).
CONCLUSIONS
Bile aspiration of more than 10 mL during EUS-HGS contributes to reducing the rate of postprocedural AEs.
背景
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。
方法
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。
结果
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）。
结论
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。
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