Department of Gastroenterology, University of Paris, Georges-Pompidou European Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France.
Department of Gastroenterology and Hepatology, University Hospitals Gasthuisberg, University of Leuven, Leuven, Belgium.
Dig Endosc. 2022 Nov;34(7):1433-1439. doi: 10.1111/den.14330. Epub 2022 May 31.
Endoscopic ultrasound-guided digestive anastomosis (EUS-A) is a new alternative under evaluation in patients presenting with afferent limb syndrome (ALS) after Whipple surgery. The aim of the present study is to analyze the safety and effectiveness of EUS-A in ALS.
This is an observational multicenter study. All patients ≥18 years old with previous Whipple surgery presenting with ALS who underwent an EUS-A using a lumen-apposing metal stent (LAMS) between 2015 and 2021 were included. The primary outcome was clinical success, defined as resolution of the ALS or ALS-related cholangitis. Furthermore, technical success, adverse event rate, and mortality were evaluated.
Forty-five patients (mean age: 65.5 ± 10.2 years; 44.4% male) were included. The most common underlying disease was pancreatic cancer (68.9%). EUS-A was performed at a median of 6 weeks after local tumor recurrence. The most common approach used was the direct/freehand technique (66.7%). Technical success was achieved in 95.6%, with no differences between large (≥15 mm) and small LAMS (97.4% vs. 100%, P = 0.664). Clinical success was retained in 91.1% of patients. A complementary treatment by dilation of the stent followed by endoscopic retrograde cholangiopancreatography through the LAMS was performed in three cases (6.7%). There were six recurrent episodes of cholangitis (14.6%) and two procedure-related adverse events (4.4%) after a median follow-up of 4 months. Twenty-six patients (57.8%) died during the follow-up due to disease progression.
EUS-A is a safe and effective technique in the treatment of malignant ALS, achieving high clinical success with an acceptable recurrence rate.
内镜超声引导下的消化道吻合术（EUS-A）是一种新的替代方案，正在评估中，用于治疗胰十二指肠切除术后出现输入袢综合征（ALS）的患者。本研究旨在分析 EUS-A 在 ALS 中的安全性和有效性。
这是一项观察性多中心研究。纳入了 2015 年至 2021 年间，因 ALS 接受过使用 lumen-apposing metal stent（LAMS）的 EUS-A 治疗的所有年龄≥18 岁、曾行胰十二指肠切除术且出现 ALS 的患者。主要结局是临床成功，定义为 ALS 或 ALS 相关胆管炎的缓解。此外，还评估了技术成功率、不良事件发生率和死亡率。
共纳入 45 例患者（平均年龄：65.5±10.2 岁；44.4%为男性）。最常见的基础疾病是胰腺癌（68.9%）。EUS-A 是在局部肿瘤复发后中位数 6 周进行的。最常用的方法是直接/徒手技术（66.7%）。技术成功率为 95.6%，大（≥15mm）和小 LAMS 之间无差异（97.4% vs. 100%，P=0.664）。91.1%的患者获得临床成功。在中位随访 4 个月后，有 3 例（6.7%）通过扩张支架并经 LAMS 行内镜逆行胰胆管造影术进行了补充治疗。有 6 例（14.6%）出现复发性胆管炎，2 例（4.4%）出现与操作相关的不良事件。26 例（57.8%）患者在随访期间因疾病进展而死亡。
EUS-A 是治疗恶性 ALS 的一种安全有效的技术，具有较高的临床成功率和可接受的复发率。
