Staroń Robert, Rzucidło Mateusz, Macierzanka Adam, Krawczyk Marcin, Gutkowski Krzysztof, Krupa Lukasz
Department of Gastroenterology and Hepatology with Internal Disease Unit, Specialist Voivodeship Hospital Frederic Chopin in Rzeszow, 35-055 Rzeszow, Poland.
Department of Colloid and Lipid Science, Gdańsk University of Technology, Gdansk, Województwo pomorskie, Poland.
BMJ Support Palliat Care. 2021 Mar 2. doi: 10.1136/bmjspcare-2020-002335.
Endoscopic biliary drainage is a first-line treatment in patients with unresectable malignant biliary obstruction. In most cases the drainage is conducted using endoscopic retrograde cholangiopancreatography (ERCP). Percutaneous transhepatic biliary drainage or endosonography-guided biliary drainage (EUS-BD) represents therapeutic options after unsuccessful ERCP. Here we report on 2 years experience in the management of patients diagnosed with malignant biliary obstruction using EUS-BD.
Retrospective data were collected on patients who underwent EUS-BD due to malignant biliary obstruction at our centre between April 2016 and April 2018. Only patients who had two unsuccessful attempts of ERCP prior to EUS-BD were included. We analysed the technical success (ie, creation of anastomosis and successful placement of a stent) and complication rate of EUS-BD, and monitored changes in serum bilirubin and liver function tests after 2 days, and at least 2 weeks, following the procedure.
Screening of 1781 ERCP procedures performed in our department during the inclusion period led to the identification of 31 patients (18 women, age range 51-92 years, 58% with pancreatic cancer) who fulfilled the inclusion criteria. Hepaticogastrostomy and choledochoduodenostomy were performed in 12 and 19 patients, respectively. The technical success rate was 97% and the complication rate was 12.9%. EUS-BD resulted in a significant decrease in serum bilirubin (p<0.01).
EUS-BD represents a reasonable therapeutic option after unsuccessful ERCP in patients with malignant biliary obstruction. Possible complications have to be kept in mind and this procedure should be performed at centres experienced in ERCP and EUS.
内镜下胆道引流是不可切除恶性胆道梗阻患者的一线治疗方法。在大多数情况下，引流通过内镜逆行胰胆管造影术（ERCP）进行。经皮经肝胆道引流或内镜超声引导下胆道引流（EUS-BD）是ERCP失败后的治疗选择。在此，我们报告使用EUS-BD治疗恶性胆道梗阻患者的2年经验。
收集2016年4月至2018年4月在本中心因恶性胆道梗阻接受EUS-BD治疗患者的回顾性数据。仅纳入在EUS-BD前ERCP两次尝试均失败的患者。我们分析了EUS-BD的技术成功率（即吻合口的建立和支架的成功置入）和并发症发生率，并在术后2天和至少2周监测血清胆红素和肝功能检查的变化。
在纳入期间对本部门进行的1781例ERCP手术进行筛查，确定31例患者（18名女性，年龄范围51-92岁，58%为胰腺癌）符合纳入标准。分别对12例和19例患者进行了肝胃吻合术和胆总管十二指肠吻合术。技术成功率为97%，并发症发生率为12.9%。EUS-BD导致血清胆红素显著降低（p<0.01）。
对于恶性胆道梗阻患者，ERCP失败后EUS-BD是一种合理的治疗选择。必须牢记可能的并发症，该手术应在有ERCP和EUS经验的中心进行。
