经内镜逆行胰胆管造影术（ERCP）联合球囊辅助内镜与超声内镜引导治疗在 Roux-en-Y 胃旁路术后胆总管结石中的应用比较。
ERCP using balloon-assisted endoscopes versus EUS-guided treatment for common bile duct stones in Roux-en-Y gastrectomy.
机构信息
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
出版信息
Gastrointest Endosc. 2024 Feb;99(2):193-203.e5. doi: 10.1016/j.gie.2023.09.001. Epub 2023 Sep 13.
BACKGROUND AND AIMS
We compared ERCP using a balloon-assisted endoscope (BE-ERCP) with EUS-guided antegrade treatment (EUS-AG) for removal of common bile duct (CBD) stones in patients with Roux-en-Y (R-Y) gastrectomy.
METHODS
Consecutive patients who had previous R-Y gastrectomy undergoing BE-ERCP or EUS-AG for CBD stones in 16 centers were retrospectively analyzed.
RESULTS
BE-ERCP and EUS-AG were performed in 588 and 59 patients, respectively. Baseline characteristics were similar, except for CBD diameter and angle. The technical success rate was 83.7% versus 83.1% (P = .956), complete stone removal rate was 78.1% versus 67.8% (P = .102), and early adverse event rate was 10.2% versus 18.6% (P = .076) in BE-ERCP and EUS-AG, respectively. The mean number of endoscopic sessions was smaller in BE-ERCP (1.5 ± .8 vs 1.9 ± 1.0 sessions, P = .01), whereas the median total treatment time was longer (90 vs 61.5 minutes, P = .001). Among patients with biliary access, the complete stone removal rate was significantly higher in BE-ERCP (93.3% vs 81.6%, P = .009). Negative predictive factors were CBD diameter ≥15 mm (odds ratio [OR], .41) and an angle of CBD <90 degrees (OR, .39) in BE-ERCP and a stone size ≥10 mm (OR, .07) and an angle of CBD <90 degrees (OR, .07) in EUS-AG. The 1-year recurrence rate was 8.3% in both groups.
CONCLUSIONS
Effectiveness and safety of BE-ERCP and EUS-AG were comparable in CBD stone removal for patients after R-Y gastrectomy, but complete stone removal after technical success was superior in BE-ERCP.
背景与目的
我们比较了经皮球囊辅助内镜逆行胰胆管造影术（BE-ERCP）与超声内镜引导下顺行治疗（EUS-AG）在 Roux-en-Y（R-Y）胃切除术后患者中用于取出胆总管（CBD）结石的效果。
方法
对 16 个中心的 588 例接受 BE-ERCP 和 59 例接受 EUS-AG 治疗 CBD 结石的 R-Y 胃切除术后患者进行回顾性分析。
结果
BE-ERCP 和 EUS-AG 的技术成功率分别为 83.7%和 83.1%（P=0.956），完全取石率分别为 78.1%和 67.8%（P=0.102），早期不良事件发生率分别为 10.2%和 18.6%（P=0.076）。BE-ERCP 的内镜操作次数更少（1.5±0.8 次 vs 1.9±1.0 次，P=0.01），但总治疗时间中位数更长（90 分钟 vs 61.5 分钟，P=0.001）。在有胆道入路的患者中，BE-ERCP 的完全取石率显著更高（93.3% vs 81.6%，P=0.009）。BE-ERCP 的阴性预测因素为 CBD 直径≥15mm（比值比 [OR]，0.41）和 CBD 角度<90 度（OR，0.39），EUS-AG 的阴性预测因素为结石大小≥10mm（OR，0.07）和 CBD 角度<90 度（OR，0.07）。两组的 1 年复发率均为 8.3%。
结论
在 R-Y 胃切除术后患者中，BE-ERCP 和 EUS-AG 在 CBD 结石清除方面的有效性和安全性相当，但在技术成功后的完全取石方面，BE-ERCP 更具优势。
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