Department of Hépato-Gastro-Entérology, CHU Limoges Hôpital Dupuytren, Service d'Hépato-Gastro-Entérologie, CHU Dupuytren, 87042, Limoges, France.
Department of Radiology, CHU Limoges Hôpital Dupuytren, Service de Radiologie, CHU Dupuytren, 87042, Limoges, France.
Surg Endosc. 2022 May;36(5):3365-3373. doi: 10.1007/s00464-021-08653-1. Epub 2021 Oct 4.
In cases of malignant distal biliary obstruction, ERCP is the preferred technique for bile duct drainage. In case of failure, the alternative techniques are percutaneous transhepatic biliary drainage (PTBD) and more recently endoscopic ultrasound-guided biliary drainage. A new type of stent called the electrocautery-enhanced lumen-apposing metal stent (EC-LAMS) has been developed to enable the performance of biliary-enteric anastomosis under EUS-guidance in a single step, without prior bile duct puncture or the need for a guidewire. The aim of our study was to compare the real-life efficacies of PTBD and EUS-BD with the EC-LAMS for cases of ERCP failure in patients with malignant biliary obstruction.
We performed a monocentric retrospective study comparing PTBD and EUS-BD with the use of electrocautery-enhanced lumen-apposing metal stent in the context of a malignant distal biliary obstruction after ERCP failure.
95 patients were included (50 in EUS-BD group and 45 in PTBD group). The main etiology of malignant obstruction was adenocarcinoma of the head of pancreas (85%). There was a significant difference in favor of endoscopic ultrasound-guided biliary drainage using electrocautery-enhanced lumen-apposing metal stent for the following criteria: clinical success: 89.3% vs. 45.5%; p < 0.0001; procedure-related adverse event rate: 2.12% vs. 22.7%; p = 0.003; duration of post-drainage hospitalization: 3.5 vs. 8.2 days; p < 0.0001, overall survival (median survival): 118.2 vs. 42 days; p = 0.012, overall cost of the strategy per patient: 5098 vs. 9363 euros; p < 0.001.
Our results are in favor of EUS-BD using electrocautery-enhanced lumen-apposing metal stent in case of ERCP failure for a distal tumor biliary obstruction. Operators performing ERCP for distal tumor biliary obstruction must learn this backup procedure because of its superiority over percutaneous transhepatic biliary drainage in terms of clinical success, safety, cost, and overall survival.
在恶性远端胆道梗阻的情况下，ERCP 是胆管引流的首选技术。如果 ERCP 失败，替代技术是经皮经肝胆管引流（PTBD）和最近的内镜超声引导下胆道引流。一种新型支架称为电烧增强型腔内置入金属支架（EC-LAMS），旨在通过超声引导下的单一操作实现胆管-肠吻合，无需预先进行胆管穿刺或使用导丝。我们的研究目的是比较 ERCP 失败后恶性胆道梗阻患者中 PTBD 和 EUS-BD 与 EC-LAMS 的实际疗效。
我们进行了一项单中心回顾性研究，比较了 ERCP 失败后恶性远端胆道梗阻患者中经皮经肝胆管引流和内镜超声引导下胆道引流与电烧增强型腔内置入金属支架的使用情况。
共纳入 95 例患者（EUS-BD 组 50 例，PTBD 组 45 例）。恶性梗阻的主要病因是胰头腺癌（85%）。内镜超声引导下胆道引流使用电烧增强型腔内置入金属支架在以下标准方面具有显著优势：临床成功率：89.3% vs. 45.5%；p<0.0001；与操作相关的不良事件发生率：2.12% vs. 22.7%；p=0.003；引流后住院时间：3.5 天 vs. 8.2 天；p<0.0001，总生存（中位生存时间）：118.2 天 vs. 42 天；p=0.012，每位患者的总体治疗策略成本：5098 欧元 vs. 9363 欧元；p<0.001。
我们的结果支持 ERCP 失败时使用电烧增强型腔内置入金属支架进行远端肿瘤性胆道梗阻的内镜超声引导下胆道引流。对于远端肿瘤性胆道梗阻进行 ERCP 的操作者必须学习这种备用程序，因为与经皮经肝胆管引流相比，它在临床成功率、安全性、成本和总生存率方面具有优势。
