Matsunami Yukitoshi, Itoi Takao, Sofuni Atsushi, Tsuchiya Takayoshi, Ishii Kentaro, Tanaka Reina, Tonozuka Ryosuke, Honjo Mitsuyoshi, Mukai Shuntaro, Nagai Kazumasa, Yamamoto Kenjiro, Asai Yasutsugu, Kurosawa Takashi, Kojima Hiroyuki, Joyama Eri, Nagakawa Yuichi
Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
Department of International Medical Care, Tokyo Medical University, Tokyo, Japan.
Endosc Ultrasound. 2021 Jul-Aug;10(4):294-304. doi: 10.4103/EUS-D-20-00232.
EUS-guided biliary drainage (EUS-BD) has recently been used for the treatment of not only malignant pancreaticobiliary diseases, but also for benign diseases. In most previous studies, EUS-BD was performed using a fully covered self-expandable metallic stent (SEMS), and data focusing on the usability of plastic stents for benign diseases are limited. We previously developed a plastic stent dedicated to EUS-guided hepaticoenterostomy (EUS-HES), and achieved favorable results in a feasibility study, although most of the patients had malignant diseases. Therefore, the aim of the present study was to evaluate the usability of dedicated plastic stents for EUS-HES in patients with benign pancreaticobiliary diseases.
A total of 57 consecutive patients (28 men, median age: 68 years; range: 7-90 years) of normal and surgically altered anatomy with benign pancreaticobiliary diseases who underwent EUS-HES using the dedicated plastic stent between Jan. 2015 and Jun. 2020 were retrospectively analyzed. Results: The overall technical success rate of EUS-HES was 92.9% (53/57). Among the 4 cases of technical failure of plastic stent placement, a SEMS was placed in 1; percutaneous transhepatic biliary drainage was performed in 1; EUS-HES was reperformed 1 week later in 1; and observational management was selected in 1 patient. Adverse events associated with the procedure were seen in 15.7% (9/57) of the patients, namely, biliary peritonitis in 4, bleeding in 2, cholecystitis in 2, and pneumoperitoneum in 1 patient. Except for 1 patient who required blood transfusion owing to bleeding and 1 patient with cholecystitis who required percutaneous transhepatic gallbladder drainage, the other 7 patients were treated by conservative therapy. There were no intervention-associated deaths.
Our results demonstrated that for patients with benign pancreaticobiliary diseases in whom conventional ERCP was unsuccessful, EUS-HES using a dedicated plastic stent was safe and feasible.
内镜超声引导下胆道引流术（EUS-BD）近来不仅用于治疗恶性胰胆疾病，也用于治疗良性疾病。在之前的大多数研究中，EUS-BD采用的是全覆膜自膨式金属支架（SEMS），而聚焦于塑料支架在良性疾病中可用性的数据有限。我们之前研发了一种专门用于内镜超声引导下肝肠吻合术（EUS-HES）的塑料支架，并且在一项可行性研究中取得了良好结果，不过大多数患者患有恶性疾病。因此，本研究的目的是评估专门的塑料支架在良性胰胆疾病患者的EUS-HES中的可用性。
回顾性分析了2015年1月至2020年6月期间连续57例（28例男性，中位年龄：68岁；范围：7 - 90岁）解剖结构正常或经手术改变且患有良性胰胆疾病、使用专门的塑料支架接受EUS-HES的患者。结果：EUS-HES的总体技术成功率为92.9%（53/57）。在4例塑料支架置入技术失败的病例中，1例置入了SEMS；1例进行了经皮经肝胆道引流；1例在1周后再次进行了EUS-HES；1例患者选择了观察性处理。15.7%（9/57）的患者出现了与手术相关的不良事件，即4例胆源性腹膜炎、2例出血、2例胆囊炎和例气腹。除了1例因出血需要输血的患者和1例胆囊炎患者需要经皮经肝胆囊引流外，其他7例患者接受了保守治疗。没有与干预相关的死亡病例。
我们的结果表明，对于常规内镜逆行胰胆管造影（ERCP）未成功的良性胰胆疾病患者，使用专门的塑料支架进行EUS-HES是安全可行的。
Zotero 插件
