使用电灼增强同轴管腔贴附、自膨式金属支架，在有和没有荧光透视的情况下，对胰液积聚进行单步内镜超声引导引流的结果。
Outcomes of a single-step endoscopic ultrasound-guided drainage of pancreatic-fluid collections using an electrocautery-enhanced coaxial lumen-apposing, self-expanding metal stent with and without fluoroscopy.
作者信息
Olaiya Babatunde, Mekaroonkamol Parit, Li Bai-Wen, Massaad Julia, Vachaparambil Cicily T, Xu Jennifer, Lamm Vladamir, Luo Hui, Shen Shan-Shan, Chen Hui-Min, Keilin Steve, Willingham Field F, Cai Qiang
机构信息
Department of Internal Medicine, Marshfield Clinic, Marshfield, WI, USA.
Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA, USA.
出版信息
Gastroenterol Rep (Oxf). 2020 Jun 4;8(6):425-430. doi: 10.1093/gastro/goaa020. eCollection 2020 Dec.
BACKGROUND
Fluoroscopy is often used during the endoscopic drainage of pancreatic-fluid collections (PFCs). An electrocautery-enhanced coaxial lumen-apposing, self-expanding metal stent (ELAMS) facilitates a single-step procedure and may avoid the need for fluoroscopy. This study compares the treatment outcomes using ELAMS with and without fluoroscopy.
METHODS
Patients with PFCs who had cystogastrostomy from January 2014 to February 2017 were enrolled. Two groups were studied based on fluoroscopy use. Technical success was defined as uneventful insertion of ELAMS at time of procedure. Clinical success was defined as (i) clinical resolution of symptoms after the procedure and (ii) >75% reduction in cyst size on computed tomography 8 weeks after stent placement. Adverse events including bleeding, stent migration, and infection were recorded.
RESULTS
A total of 21 patients (13 males) had PFCs drainage with ELAMS in the study period. The mean age was 51.6 ± 14.2 years. Thirteen patients had walled-off necrosis while eight had a pancreatic pseudocyst. The mean size of the PFCs was 11.3 ± 3.3 cm. Fluoroscopy was used in seven cases (33%) and was associated with a longer procedure time compared to non-fluoroscopy (43.1 ± 10.4 vs 33.3 ± 10.5 min, =0.025). This association was independent of the size, location, or type of PFCs. Fluoroscopy had no effect on the technical success rates. In fluoroless procedures, the clinical resolution was 91% as compared to 71% in fluoroscopy procedures (=0.52) and the radiologic resolution was 57% as compared to 71% in fluoroscopy procedures (=0. 65). Three cases of stent migration/displacement occurred in the fluoroless procedures.
CONCLUSIONS
ELAMS may avoid the need for fluoroscopy during cystogastrostomy. Procedures without fluoroscopy were significantly shorter and fluoroscopy use had no impact on the technical or clinical success rates.
背景
在胰液积聚（PFCs）的内镜引流过程中经常使用荧光透视法。一种电灼增强的同轴管腔贴合、自膨式金属支架（ELAMS）有助于单步操作，并且可能避免使用荧光透视法。本研究比较了使用和不使用荧光透视法的ELAMS治疗效果。
方法
纳入2014年1月至2017年2月期间接受胃囊肿造口术的PFCs患者。根据是否使用荧光透视法分为两组进行研究。技术成功定义为手术时ELAMS顺利置入。临床成功定义为：（i）术后症状临床缓解；（ii）支架置入8周后计算机断层扫描显示囊肿大小缩小>75%。记录包括出血、支架移位和感染在内的不良事件。
结果
在研究期间，共有21例患者（13例男性）接受了ELAMS的PFCs引流。平均年龄为51.6±14.2岁。13例为包裹性坏死，8例为胰腺假性囊肿。PFCs的平均大小为11.3±3.3cm。7例（33%）使用了荧光透视法，与未使用荧光透视法相比，手术时间更长（43.1±10.4分钟对33.3±10.5分钟，P=0.025）。这种关联与PFCs的大小、位置或类型无关。荧光透视法对技术成功率没有影响。在无荧光透视的手术中，临床缓解率为91%，而在有荧光透视的手术中为71%（P=0.52）；放射学缓解率为57%，而在有荧光透视的手术中为71%（P=0.65）。在无荧光透视的手术中有3例发生支架移位/脱位。
结论
ELAMS在胃囊肿造口术期间可能避免使用荧光透视法。无荧光透视的手术时间明显更短，且使用荧光透视法对技术或临床成功率没有影响。
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