Kanadani Takafumi, Ogura Takeshi, Ueno Saori, Okuda Atsushi, Nishioka Nobu, Nakamura Junichi, Yamada Masanori, Uba Yuki, Tomita Mitsuki, Hattori Nobuhiro, Sakamoto Jun, Nishikawa Hiroki
2nd Department of Internal Medicine, Osaka Medical College, Takatsuki-shi, Japan.
Endoscopic Center, Osaka Medical and Pharmaceutical University, Takatsuki, Japan.
Endosc Int Open. 2024 Feb 12;12(2):E181-E187. doi: 10.1055/a-2218-1538. eCollection 2024 Feb.
Balloon dilation and plastic stent deployment have been performed as hepaticojejunostomy stricture (HJS) treatment techniques under endoscopic ultrasound guidance (EUS). Although these techniques have shown favorable clinical results, the treatment period can be long because stent deployment is required. In addition, HJS may recur even after treatment because the scar tissue itself remains. To overcome these challenges, we developed an EUS-guided antegrade drill dilation technique for treating HJS. The aim of this study was to evaluate the technical feasibility and safety of this technique in terms of the pre- and post-cholangioscopic findings. This retrospective study included consecutive patients whose conditions were complicated with symptomatic HJS between November 2022 and February 2023. Transluminal antegrade drill dilation (TAD) using a novel drill dilator was attempted within 14 days after EUS-guided hepaticogastrostomy (HGS). HJS was diagnosed with cholangioscopy before TAD, and resolution was evaluated after TAD using cholangioscopy. TAD was attempted at approximately 11 days after EUS-HGS. The cholangioscope was inserted successfully in all patients after this procedure. Cholangioscopy revealed stricture without evidence of malignancy in 19 patients. In the remaining three patients, stricture was not observed and these patients underwent stent exchange rather than TAD. Among the 19 patients, passage of the guidewire across the HJS into the intestine was unsuccessful in four patients, and the technical success rate for this procedure was 78.9%. TAD was successful in all 15 patients in whom passage of the guidewire was achieved. In conclusion, TAD appears to be technically feasible and safe.
在超声内镜引导下（EUS），球囊扩张和塑料支架置入已被用作肝空肠吻合术狭窄（HJS）的治疗技术。尽管这些技术已显示出良好的临床效果，但由于需要置入支架，治疗周期可能较长。此外，由于瘢痕组织仍然存在，HJS即使在治疗后也可能复发。为了克服这些挑战，我们开发了一种用于治疗HJS的超声内镜引导下顺行钻孔扩张技术。本研究的目的是根据胆管镜检查前后的结果评估该技术的技术可行性和安全性。这项回顾性研究纳入了2022年11月至2023年2月期间因症状性HJS而病情复杂的连续患者。在超声内镜引导下肝胃吻合术（HGS）后14天内，尝试使用新型钻孔扩张器进行经腔顺行钻孔扩张（TAD）。在TAD前通过胆管镜检查诊断HJS，并在TAD后使用胆管镜检查评估狭窄的缓解情况。TAD在EUS-HGS后约11天进行。在此操作后，所有患者的胆管镜均成功插入。胆管镜检查显示19例患者存在狭窄且无恶性证据。在其余3例患者中，未观察到狭窄，这些患者接受了支架置换而非TAD。在这19例患者中，4例患者的导丝未能穿过HJS进入肠道，该操作的技术成功率为78.9%。在导丝通过成功的所有15例患者中，TAD均成功。总之，TAD在技术上似乎是可行和安全的。
