Doyon Theo, Maniere Thibault, Désilets Étienne
Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke J1H 7N4, Québec, Canada.
Department of Gastroenterology, Hopital Charles-Lemoyne, Greenfield Park J4V 2H1, Québec, Canada.
World J Gastrointest Endosc. 2022 May 16;14(5):335-341. doi: 10.4253/wjge.v14.i5.335.
Endoscopic ultrasonography (EUS) has evolved in the last years making it not only a diagnostic modality but a therapeutic procedure. EUS is now used as an alternative technique to percutaneous and surgical drainage. Even though EUS is a challenging procedure and not always suitable compared to percutaneous drainage, there is a need for developing new therapeutic approaches to the liver for when percutaneous drainage is not feasible.
We present the case of a 82 years old male who developed an infected subcapsular hepatic hematoma (SHH) of the left lobe following percutaneous biliary drainage. After 2 failed attempts of percutaneous drainage of the SHH and because the patients couldn't withstand surgery, we conducted a EUS drainage and debridement of the SHH. Using a lumen apposing metal stent (LAMS) by a transgastric approach, we were able to gain endoscopic access to the SHH. With our experience in the debridement of walled off pancreatic necrosis using this technique, we were confident it was the right approach. After four debridement sessions, the computed tomography scan showed a clear regression of the SHH.
To our knowledge, this is the first case of successful endoscopic debridement of a SHH using a LAMS which appear to be feasible and safe in this specific case.
近年来，内镜超声检查（EUS）不断发展，不仅成为一种诊断方式，还成为一种治疗手段。EUS现被用作经皮引流和手术引流的替代技术。尽管EUS是一项具有挑战性的操作，与经皮引流相比并不总是适用，但在经皮引流不可行时，仍需要开发针对肝脏的新治疗方法。
我们报告一例82岁男性患者，该患者在经皮胆道引流后发生左叶感染性肝包膜下血肿（SHH）。在两次经皮引流SHH失败且患者无法耐受手术之后，我们对SHH进行了EUS引流和清创术。通过经胃途径使用管腔对合金属支架（LAMS），我们得以在内镜下进入SHH。鉴于我们使用该技术清创包裹性胰腺坏死的经验，我们确信这是正确的方法。经过四次清创术后，计算机断层扫描显示SHH明显消退。
据我们所知，这是首例使用LAMS成功内镜清创SHH的病例，在该特定病例中，LAMS似乎可行且安全。
