Vargas-Madrigal Jorge, Chan Shannon M, Dhar Jahnvi, Teoh Anthony Y B, Samanta Jayanta, Lakhtakia Sundeep, Giovannini Marc
Gastroenterology, Hospital San Juan de Dios, Caja Costarricense de Seguro Social, San Jose, Costa Rica.
Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, Hong Kong.
Endoscopy. 2024 Nov;56(11):864-869. doi: 10.1055/a-2340-7432. Epub 2024 Jun 7.
Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is an alternative for biliary drainage in patients with obstructive pancreaticobiliary pathology when endoscopic retrograde cholangiopancreatography (ERCP) is not feasible. Despite its effectiveness, EUS-HGS is associated with a significant risk of adverse events. This study aimed to evaluate the feasibility and safety of a newly designed dedicated cautery-enhanced tubular self-expandable metal stent (SEMS) for EUS-HGS.
This multicenter prospective study included patients with malignant biliary obstruction in whom ERCP had failed because of tumor infiltration, inability to drain the intrahepatic ducts, or surgically altered anatomy. A dedicated cautery-enhanced tubular SEMS was used for EUS-HGS. Technical and clinical success rates, procedure times, and adverse events were evaluated.
20 patients underwent EUS-HGS with the dedicated stent. Technical and clinical success rates of 100% were achieved, with no reported severe adverse events or mortality. The median procedure time was 16 minutes. Recurrent biliary obstruction was observed in 1 patient.
The dedicated cautery-enhanced tubular SEMS for EUS-HGS can simplify the procedure and enhance its safety and efficacy. This innovation shows promise for improving patient outcomes, although further studies are needed to validate these findings in a broader patient population.
当内镜逆行胰胆管造影术（ERCP）不可行时，内镜超声引导下肝胃吻合术（EUS-HGS）是梗阻性胰胆管疾病患者胆汁引流的一种替代方法。尽管EUS-HGS有效，但它与不良事件的显著风险相关。本研究旨在评估一种新设计的用于EUS-HGS的专用烧灼增强型管状自膨式金属支架（SEMS）的可行性和安全性。
这项多中心前瞻性研究纳入了因肿瘤浸润、无法引流肝内胆管或手术改变解剖结构而导致ERCP失败的恶性胆管梗阻患者。使用专用的烧灼增强型管状SEMS进行EUS-HGS。评估技术成功率、临床成功率、手术时间和不良事件。
20例患者接受了使用专用支架的EUS-HGS。技术成功率和临床成功率均达到100%，未报告严重不良事件或死亡。中位手术时间为16分钟。1例患者出现复发性胆管梗阻。
用于EUS-HGS的专用烧灼增强型管状SEMS可简化手术并提高其安全性和有效性。尽管需要进一步研究以在更广泛的患者群体中验证这些发现，但这项创新显示出改善患者预后的前景。
