Department of Gastroenterology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, No.185 Juqianjie Road, Changzhou, 213003, Jiangsu, China.
Department of Gastroenterology, The Second Affiliated Hospital of Xuzhou Medical University, General Hospital of XuZhou Mining Group, Xuzhou, China.
Surg Endosc. 2022 Aug;36(8):5930-5937. doi: 10.1007/s00464-022-09117-w. Epub 2022 Feb 17.
This study was aimed at comparing the safety and effectiveness of endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) and EUS-HGS combined with antegrade stenting (EUS-HGAS) in patients with malignant biliary obstruction (MBO) after failed endoscopic retrograde cholangiopancreatography (ERCP).
Patients diagnosed with MBO and receiving EUS-HGS or EUS-HGAS from September 2015 to October 2020 were enrolled in this study. Clinical success, complications, reintervention rate, post-operative hospital stay, time to stent dysfunction, and patient death were compared.
A total of 45 patients (21 in the EUS-HGAS group and 24 in the EUS-HGS group) were enrolled in this study. In the EUS-HGAS group, 21 patients all achieved clinical success (100%); in the EUS-HGS group, 24 patients also achieved technical success (100%) (P > 0.05). The differences between pre- and post-operative TB and ALT and AST levels were greater in the single-step EUS-HGAS group (P < 0.05). The incidence of complications was 2 of 21 (9.5%) in the EUS-HGAS group and 5 of 24 (20.8%) in the EUS-HGS group (P > 0.05). The reintervention rate was 0 in the EUS-HGAS group and 1 (4.2%) in the EUS-HGS group (P > 0.05). Time to stent dysfunction or patient death was longer in the EUS-HGAS group (P < 0.05). The post-operative hospital stay was longer and the total cost was higher in the EUS-HGAS group.
EUS-HGAS was superior to EUS-HGS in terms of biliary drainage effectiveness and time to stent dysfunction or patient death in patients with MBO after failed ERCP. Furthermore, two-step EUS-HGAS may be safer in some patients.
本研究旨在比较内镜超声引导下肝胃吻合术（EUS-HGS）和内镜超声引导下肝胃吻合术联合顺行支架置入术（EUS-HGAS）治疗内镜逆行胰胆管造影术（ERCP）失败后恶性胆道梗阻（MBO）患者的安全性和有效性。
本研究纳入了 2015 年 9 月至 2020 年 10 月期间接受 EUS-HGS 或 EUS-HGAS 治疗的 MBO 患者。比较了临床成功率、并发症发生率、再介入率、术后住院时间、支架功能障碍或患者死亡时间。
本研究共纳入 45 例患者（EUS-HGAS 组 21 例，EUS-HGS 组 24 例）。EUS-HGAS 组 21 例患者均获得临床成功（100%）；EUS-HGS 组 24 例患者均获得技术成功（100%）（P>0.05）。EUS-HGAS 组术前和术后 TB 和 ALT、AST 水平的差异均大于 EUS-HGS 组（P<0.05）。EUS-HGAS 组并发症发生率为 2 例（9.5%），EUS-HGS 组为 5 例（20.8%）（P>0.05）。EUS-HGAS 组再介入率为 0，EUS-HGS 组为 1 例（4.2%）（P>0.05）。EUS-HGAS 组支架功能障碍或患者死亡时间较长（P<0.05）。EUS-HGAS 组术后住院时间较长，总费用较高。
在 ERCP 失败后发生 MBO 的患者中，EUS-HGAS 在胆道引流效果和支架功能障碍或患者死亡时间方面优于 EUS-HGS。此外，两步法 EUS-HGAS 对某些患者可能更安全。
