Ogura Takeshi, Itoi Takao
2nd Department of Internal Medicine Osaka Medical College Osaka Japan.
Depaertment of Gastroenterology and Hepatology Tokyo Medical University Tokyo Japan.
DEN Open. 2021 Apr 21;1(1):e8. doi: 10.1002/deo2.8. eCollection 2021 Apr.
Various efforts to improve technical success rates and decrease adverse event rates have also been described in endoscopic ultrasound (EUS)-guided choledochoduodenostomy (CDS). In particular, lumen-apposing metal stents (LAMS) may open novel opportunities in EUS-biliary drainage (BD). To date, various studies have been reported with EUS-CDS using LAMS, so we should clarify the benefits and limitations of recent EUS-CDS based on developments in both techniques and devices. In this review, we provide technical tips and describe recent developments in EUS-CDS, along with a review of the recent literature (between 2015 and 2020). The overall technical success rate is 95.0% (939/988), and the overall clinical success rate is 97.0% (820/845). The most frequent adverse event is cholangitis or cholecystitis (24.5%, 27/110). According to previous review, pneumoperitoneum (28%, 9/34) or peritonitis associated with bile leak (23.5%, 8/34) was most commonly observed. This difference might be based on improvements in dilation devices or the use of covered metal stents. Several randomized controlled trials comparing EUS-CDS and endoscopic retrograde cholangiopancreatography (ERCP) for malignant biliary obstruction have recently been reported. To summarize, overall technical success rates for ERCP and EUS-CDS were 92.7% (101/109) and 91.1% (72/79), respectively ( = 0.788). Overall clinical success rates for ERCP and EUS-CDS were 94.1% (96/102) and 93.6% (72/78), respectively ( = 0.765). Further high-quality evidence is needed to establish EUS-CDS as a primary drainage technique.
在内镜超声（EUS）引导下的胆总管十二指肠吻合术（CDS）中，也描述了各种提高技术成功率和降低不良事件发生率的努力。特别是，管腔贴附金属支架（LAMS）可能为EUS胆管引流（BD）开辟新的机会。迄今为止，已经报道了多项使用LAMS进行EUS-CDS的研究，因此我们应该根据技术和设备的发展情况，阐明近期EUS-CDS的益处和局限性。在这篇综述中，我们提供了技术要点，描述了EUS-CDS的最新进展，并对近期文献（2015年至2020年）进行了回顾。总体技术成功率为95.0%（939/988），总体临床成功率为97.0%（820/845）。最常见的不良事件是胆管炎或胆囊炎（24.5%，27/110）。根据之前的综述，最常观察到的是气腹（28%，9/34）或与胆漏相关的腹膜炎（23.5%，8/34）。这种差异可能基于扩张设备的改进或覆膜金属支架的使用。最近有几项比较EUS-CDS和内镜逆行胰胆管造影（ERCP）治疗恶性胆管梗阻的随机对照试验被报道。总之，ERCP和EUS-CDS的总体技术成功率分别为92.7%（101/109）和91.1%（72/79）（P = 0.788）。ERCP和EUS-CDS的总体临床成功率分别为94.1%（96/102）和93.6%（72/78）（P = 0.765）。需要进一步的高质量证据来确立EUS-CDS作为主要引流技术的地位。
