Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Endoscopy and Endoscopic Surgery, The University of Tokyo, Tokyo, Japan.
Surg Endosc. 2024 May;38(5):2423-2432. doi: 10.1007/s00464-024-10738-6. Epub 2024 Mar 7.
Balloon endoscopy-assisted endoscopic retrograde cholangiopancreatography (BE-ERCP) is an emerging procedure for pancreatobiliary diseases in patients with surgically altered anatomy. However, data on BE-ERCP for hepatolithiasis after hepaticojejunostomy (HJS) are still limited.
Stone removal success, adverse events and recurrence were retrospectively studied in consecutive patients who underwent BE-ERCP for hepatolithiasis after HJS between January 2011 and October 2022. Subgroup analysis was performed to compare clinical outcomes between patients who had undergone HJS over 10 years before (past HJS group) and within 10 years (recent HJS group).
A total of 131 patients were included; 39% had undergone HJS for malignancy and 32% for congenital biliary dilation. Scope insertion and complete stone removal were successful in 89% and 73%, respectively. Early adverse events were observed in 9.9%. Four patients (3.1%) developed gastrointestinal perforation but could be managed conservatively. Hepatolithiasis recurrence rate was 17%, 20% and 31% in 1-year, 3-year, and 5-year after complete stone removal. The past HJS group was the only risk factor for failed stone removal (odds ratio 10.4, 95% confidence interval 2.99-36.5) in the multivariable analysis. Failed scope insertion (20%) and failed guidewire or device insertion to the bile duct (22%) were two major reasons for failed stone removal in the past HJS group.
BE-ERCP for hepatolithiasis was effective and safe in cases with HJS but the complete stone removal rate was low in the past HJS group. Recurrent hepatolithiasis was common and careful follow up study is needed even after complete stone removal.
球囊辅助内镜逆行胰胆管造影术（BE-ERCP）是一种用于解剖结构改变的胰胆疾病的新兴方法。然而，关于胆肠吻合术后（HJS）肝内胆管结石行 BE-ERCP 的数据仍然有限。
回顾性分析 2011 年 1 月至 2022 年 10 月期间连续接受 HJS 后肝内胆管结石行 BE-ERCP 的患者的取石成功率、不良事件和复发情况。对 10 年前（既往 HJS 组）和 10 年内（近期 HJS 组）行 HJS 的患者进行了亚组分析，比较了临床结局。
共纳入 131 例患者，39%的患者因恶性肿瘤而行 HJS，32%的患者因先天性胆管扩张而行 HJS。89%的患者成功插入内镜，73%的患者成功完全取石。早期不良事件发生率为 9.9%。4 例（3.1%）患者发生胃肠穿孔，但可保守治疗。完全取石后 1 年、3 年和 5 年的胆石复发率分别为 17%、20%和 31%。多变量分析显示，既往 HJS 是取石失败的唯一危险因素（比值比 10.4，95%置信区间 2.99-36.5）。既往 HJS 组中，取石失败的两个主要原因是内镜插入失败（20%）和导丝或器械插入胆管失败（22%）。
HJS 后行 BE-ERCP 治疗肝内胆管结石是有效且安全的，但既往 HJS 组的完全取石率较低。复发性胆石症很常见，即使在完全取石后也需要仔细随访研究。
