Nennstiel Simon, Freivogel Kathrin, Faber Alexander, Schlag Christoph, Haller Bernhard, Blöchinger Martin, Dollhopf Markus, Lewerenz Björn, Schepp Wolfgang, Schirra Jörg, Schmid Roland M, Neu Bruno
Medizinische Klinik und Poliklinik Für Innere Medizin II, Klinikum Rechts der Isar der TU München, Ismaninger Str. 22, 81675, Munich, Germany.
Innere Medizin I, Krankenhaus Barmherzige Brüder München, Romanstraße 93, 80639, Munich, Germany.
Surg Endosc. 2021 Dec;35(12):6853-6864. doi: 10.1007/s00464-020-08191-2. Epub 2021 Jan 4.
In patients with altered upper gastrointestinal anatomy, conventional endoscopic retrograde cholangiography is often not possible and different techniques, like enteroscopy-assisted or percutaneous approaches are required. Aim of this study was to analyze success and complication rates of these techniques in a large collective of patients in the daily clinical practice in a pre-endosonographic biliary drainage era.
Patients with altered upper gastrointestinal anatomy with biliary interventions between March 1st, 2006, and June 30th, 2014 in four tertiary endoscopic centers in Munich, Germany were retrospectively analyzed.
At least one endoscopic-assisted biliary intervention was successful in 234/411 patients (56.9%)-in 192 patients in the first, in 34 patients in the second and in 8 patients in the third attempt. Success rates for Billroth-II/Whipple-/Roux-en-Y reconstruction were 70.5%/56.7%/49.5%. Complication rates for these reconstructions were 9.3%/6.5%/6.3%, the overall complication rate was 7.1%. Success rates were highest in patients with Billroth-II reconstruction where use of a duodenoscope was possible, complication rates were also highest in this scenario. Success rates were lowest in longer-limb anatomy like Roux-en-Y reconstruction. Percutaneous biliary drainages (PTBD) were inserted 268 times with substantially higher success (90.7%) as well as complication rates (11.6%) compared to the endoscopic approach. Compared to patients treated endoscopically, patients with PTBD had a lower performance status, more severe cholestasis and a significant higher rate of malignant underlying disease.
In patients with altered upper gastrointestinal anatomy, success rates of endoscopic-assisted biliary interventions are lower compared to PTBD. Still, due to the beneficial complication rates of the endoscopic approach, this technique should be preferred whenever possible and in selected patients who still need to be defined in detail, repeated endoscopic attempts are useful to help achieve the desired result.
在上消化道解剖结构改变的患者中，传统的内镜逆行胆管造影术通常无法实施，需要采用不同的技术，如肠镜辅助或经皮途径。本研究的目的是在超声内镜引导下胆道引流时代之前的日常临床实践中，分析这些技术在大量患者中的成功率和并发症发生率。
回顾性分析2006年3月1日至2014年6月30日期间在德国慕尼黑的四个三级内镜中心接受胆道干预的上消化道解剖结构改变的患者。
至少一次内镜辅助胆道干预在234/411例患者（56.9%）中成功——首次尝试成功192例，第二次尝试成功34例，第三次尝试成功8例。毕罗Ⅱ式/惠普尔/空肠袢Y形重建术的成功率分别为70.5%/56.7%/49.5%。这些重建术的并发症发生率分别为9.3%/6.5%/6.3%，总体并发症发生率为7.1%。在可以使用十二指肠镜的毕罗Ⅱ式重建患者中成功率最高，在这种情况下并发症发生率也最高。在如空肠袢Y形重建等长袢解剖结构患者中成功率最低。与内镜途径相比，经皮胆道引流（PTBD）进行了268次，成功率显著更高（90.7%），但并发症发生率（11.6%）也更高。与接受内镜治疗的患者相比，接受PTBD的患者身体状况较差，胆汁淤积更严重，恶性基础疾病的发生率显著更高。
在上消化道解剖结构改变的患者中，内镜辅助胆道干预的成功率低于PTBD。尽管如此，由于内镜途径并发症发生率较低，只要有可能，对于仍需详细确定的特定患者，应首选该技术，反复进行内镜尝试有助于获得理想结果。
