Takeshita Kotaro, Hijioka Susumu, Nagashio Yoshikuni, Maruki Yuta, Ohba Akihiro, Kawasaki Yuki, Hisada Yuya, Yoshinari Motohiro, Harai Shota, Kitamura Hidetoshi, Koga Takehiko, Maehara Kosuke, Murashima Yumi, Yamada Natsumi, Okada Mao, Takasaki Tetsuro, Agarie Daiki, Hara Hidenobu, Hagiwara Yuya, Okamoto Kohei, Yamashige Daiki, Kondo Shunsuke, Morizane Chigusa, Ueno Hideki, Saito Yutaka, Okusaka Takuji
Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Japan, Tokyo, Japan.
Endoscopy Division, National Cancer Center Japan, Tokyo, Japan.
Endosc Int Open. 2023 Jan 26;11(1):E97-E104. doi: 10.1055/a-1997-9149. eCollection 2023 Jan.
Recently, the utility of endoscopic ultrasound-guided intervention without fistula dilation (EUS-IV WoD) has been reported to prevent adverse events. We clinically evaluated cases in which EUS-IV WoD was attempted using a novel self-expandable metallic stent (SEMS); this is a fully covered, laser-cut SEMS that has a tapered and stiff tip specifically designed for a 0.025-inch guidewire and a relatively thin, 7F delivery system. We retrospectively evaluated cases wherein EUS-IV WoD was attempted using the novel SEMS between March and December 2021. Treatment of 11 patients by EUS-IV WoD with the novel SEMS was attempted. The technical success rate for EUS-IV was 100 % and the clinical success rate was 100 %; the success rate for EUS-IV WoD was 72.8 %. Of these, the procedural success rate for EUS-IV WoD was 100 % in EUS-biliary drainage (BD) and 57.1 % in non-EUS-BD. Early adverse events were observed in 27.3 % of patients (3/11): mild abdominal pain in two patients and moderate bleeding in one patient. The abdominal pain cases were both cases of EUS-IV WoD failure and required fistula dilation. The novel stent may be useful for EUS-IV WoD, especially in EUS-BD.
最近，有报道称内镜超声引导下不进行瘘管扩张的介入治疗（EUS-IV WoD）可预防不良事件。我们对使用新型自膨式金属支架（SEMS）尝试进行EUS-IV WoD的病例进行了临床评估；这是一种全覆膜、激光切割的SEMS，其尖端呈锥形且坚硬，专为0.025英寸导丝设计，输送系统相对较细，为7F。我们回顾性评估了2021年3月至12月期间使用新型SEMS尝试进行EUS-IV WoD的病例。尝试对11例患者采用新型SEMS进行EUS-IV WoD治疗。EUS-IV的技术成功率为100%，临床成功率为100%；EUS-IV WoD的成功率为72.8%。其中，EUS-IV WoD在EUS胆管引流（BD）中的操作成功率为100%，在非EUS-BD中的操作成功率为57.1%。27.3%的患者（3/11）出现早期不良事件：2例患者出现轻度腹痛，1例患者出现中度出血。腹痛病例均为EUS-IV WoD失败病例，需要进行瘘管扩张。这种新型支架可能对EUS-IV WoD有用，尤其是在EUS-BD中。
