急性胆管炎患者的紧急早期内镜超声引导下胆道引流
Urgent and early EUS-guided biliary drainage in patients with acute cholangitis.
作者信息
Mukai Shuntaro, Itoi Takao, Sofuni Atsushi, Tsuchiya Takayoshi, Ishii Kentaro, Tanaka Reina, Tonozuka Ryosuke, Honjo Mitsuyoshi, Yamamoto Kenjiro, Nagai Kazumasa, Matsunami Yukitoshi, Asai Yasutsugu, Kurosawa Takashi, Kojima Hiroyuki, Homma Toshihiro, Minami Hirohito, Nagakawa Yuichi
机构信息
Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan.
出版信息
Endosc Ultrasound. 2021 May-Jun;10(3):191-199. doi: 10.4103/eus.eus_70_20.
BACKGROUND AND OBJECTIVES
EUS-guided biliary drainage (EUS-BD) has been reported as an effective alternative drainage technique. However, clinical data on EUS-BD for patients with acute cholangitis (AC) are limited. The aim of this study was to analyze the clinical outcomes of EUS-BD in patients with AC.
PATIENTS AND METHODS
Nineteen patients with AC who underwent urgent or early drainage (within 96 h) by EUS-guided hepaticoenterostomy (EUS-HES) between January 2014 and November 2019 were retrospectively reviewed. Furthermore, the clinical outcomes of EUS-HES using a plastic stent in the AC group (n = 15) were compared to those in the non-AC group (n = 88).
RESULTS
In the 19 AC cases, the technical and clinical success rate was 100% with 5.3% of moderate adverse events (biliary peritonitis [n = 1]). Regarding the comparison between the AC group and the non-AC group, the clinical success rate was 100% in both groups and the adverse event rate was not statistically significantly different (P = 0.88). Although the recurrent biliary obstruction (RBO) rate was not statistically significantly different (P = 0.43), the early RBO rate was statistically significantly higher in the AC group (26.7% vs. 3.4%, P < 0.001). Kaplan-Meier curves showed that AC was associated with a shorter time to RBO (P = 0.046). The presence of AC was found to be an independent risk factor of early RBO (odds ratio = 10.3; P = 0.005).
CONCLUSIONS
Urgent or early biliary drainage (within 96 h) by EUS-BD can be a feasible and safe alternative procedure for patients with AC, although there is a tendency of early RBO.
背景与目的
内镜超声引导下胆道引流术（EUS-BD）已被报道为一种有效的替代引流技术。然而，关于急性胆管炎（AC）患者接受EUS-BD的临床数据有限。本研究的目的是分析AC患者接受EUS-BD的临床结局。
患者与方法
回顾性分析2014年1月至2019年11月期间19例接受急诊或早期（96小时内）内镜超声引导下肝肠吻合术（EUS-HES）的AC患者。此外，比较了AC组（n = 15）和非AC组（n = 88）使用塑料支架行EUS-HES的临床结局。
结果
在19例AC病例中，技术成功率和临床成功率均为100%，中度不良事件发生率为5.3%（胆源性腹膜炎[n = 1]）。AC组与非AC组比较，两组临床成功率均为100%，不良事件发生率差异无统计学意义（P = 0.88）。虽然复发性胆管梗阻（RBO）率差异无统计学意义（P = 0.43），但AC组早期RBO率显著高于非AC组（26.7%对3.4%，P < 0.001）。Kaplan-Meier曲线显示，AC与RBO发生时间较短相关（P = 0.046）。AC的存在是早期RBO的独立危险因素（比值比 = 10.3；P = 0.005）。
结论
尽管存在早期RBO的趋势，但对于AC患者，急诊或早期（96小时内）行EUS-BD是一种可行且安全的替代手术。
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