Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
J Gastroenterol Hepatol. 2024 Mar;39(3):552-559. doi: 10.1111/jgh.16442. Epub 2023 Dec 18.
Endoscopic ultrasound (EUS)-guided biliary drainage is being increasingly performed as an alternative to percutaneous transhepatic biliary drainage (PTBD) to treat malignant hilar obstruction (MHO) after failed endoscopic retrograde cholangiopancreatography (ERCP). However, no study has compared EUS-guided hepaticoduodenostomy (EUS-HDS) with PTBD for right intrahepatic duct (IHD) obstruction after failed ERCP in patients with unresectable MHO.
We retrospectively reviewed the data of consecutive patients with right IHD obstruction developed by unresectable MHO who underwent EUS-HDS or PTBD after a previous placement of a stent in the left and/or right IHD between March 2018 and October 2021. Technical success, clinical success, stent or tube-related adverse events, frequency of reintervention, and stent patency were evaluated.
A total of 42 patients (18 EUS-HDS, 24 PTBD) were analyzed. Both groups did not show significant differences in technical success (EUS-HDS, 94% vs PTBD, 100%; P = 0.429), clinical success (83% vs 83%; P = 0.999), early adverse events (24% vs 46%; P = 0.144), and stent or tube-related late adverse events (29% vs 54%; P = 0.116). During follow-up, the EUS-HDS group had a longer median duration of patency (131 days vs 58.5 days; P = 0.041), and lower mean frequency of reinterventions per patient (0.35 vs 1.92; P = 0.030) than the PTBD group.
EUS-HDS showed comparable efficacy and safety to PTBD for drainage of the right biliary system and produced longer duration of patency and lower frequency of reinterventions in patients with unresectable MHO.
内镜超声（EUS）引导下胆道引流术作为经皮经肝胆道引流术（PTBD）的替代方法，越来越多地用于治疗内镜逆行胰胆管造影术（ERCP）失败后恶性肝门部梗阻（MHO）。然而，尚无研究比较 EUS 引导下肝十二指肠吻合术（EUS-HDS）与 PTBD 治疗不可切除 MHO 患者 ERCP 后右肝内胆管（IHD）阻塞。
我们回顾性分析了 2018 年 3 月至 2021 年 10 月期间连续接受 EUS-HDS 或 PTBD 治疗的不可切除 MHO 患者中，由于不可切除的 MHO 导致右 IHD 阻塞且在左和/或右 IHD 中放置支架后的右 IHD 阻塞患者的数据。评估了技术成功率、临床成功率、支架或管相关不良事件、再介入频率和支架通畅性。
共分析了 42 例患者（EUS-HDS 组 18 例，PTBD 组 24 例）。两组在技术成功率（EUS-HDS 组 94% vs PTBD 组 100%；P=0.429）、临床成功率（83% vs 83%；P=0.999）、早期不良事件（24% vs 46%；P=0.144）和支架或管相关晚期不良事件（29% vs 54%；P=0.116）方面无显著差异。在随访期间，EUS-HDS 组的中位通畅时间（131 天 vs 58.5 天；P=0.041）和每位患者的平均再介入频率（0.35 次 vs 1.92 次；P=0.030）均长于 PTBD 组。
EUS-HDS 与 PTBD 相比，在引流右胆道系统方面具有相似的疗效和安全性，并且在不可切除的 MHO 患者中产生了更长的通畅时间和更低的再介入频率。
