Yu Tingting, Hou Suning, Du Haiming, Zhang Wei, Tian Jiao, Hou Yankun, Yao Jun, Hou Senlin, Zhang Lichao
The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China.
Jinan University of Second Clinical Medical Sciences, Shenzhen People's Hospital, Shenzhen, Guangdong, P. R. China.
Gastroenterol Rep (Oxf). 2024 Jun 25;12:goae056. doi: 10.1093/gastro/goae056. eCollection 2024.
Endoscopic ultrasound (EUS)-guided transhepatic antegrade stone removal (TASR) has been reserved for choledocholithiasis after failed endoscopic retrograde cholangiopancreatography (ERCP) in recent years. The aim of this study was to evaluate the techniques, feasibility, and safety of simplified single-session EUS-TASR for choledocholithiasis in patients with surgically altered anatomy (SAA).
A retrospective database of patients with SAA and choledocholithiasis from the Second Hospital of Hebei Medical University (Shijiazhuang, China) between August 2020 and February 2023 was performed. They all underwent single-session EUS-TASR after ERCP failure. Basic characteristics of the patients and details of the procedures were collected. The success rates and adverse events were evaluated and discussed.
During the study period, 13 patients underwent simplified single-session EUS-TASR as a rescue procedure (8 males, median age, 64.0 [IQR, 48.5-69.5] years). SAA consisted of four Whipple procedures, one Billroth II gastrectomy, four gastrectomy with Roux-en-Y anastomoses, and four hepaticojejunostomy with Roux-en-Y anastomoses. The technical success rate was 100% and successful bile duct stone removal was achieved in 12 of the patients (92.3%). Adverse events occurred in two patients (15.4%), while one turned to laparoscopic surgery and the other was managed conservatively.
Simplified single-session EUS-TASR as a rescue procedure after ERCP failure appeared to be effective and safe in the management of choledocholithiasis in patients with SAA. But further evaluation of this technique is still needed, preferably through prospective multicenter trials.
近年来，内镜超声（EUS）引导下经肝顺行取石术（TASR）已被用于内镜逆行胰胆管造影术（ERCP）失败后的胆总管结石治疗。本研究旨在评估简化的单次EUS-TASR治疗手术解剖结构改变（SAA）患者胆总管结石的技术、可行性和安全性。
对2020年8月至2023年2月期间河北医科大学第二医院（中国石家庄）收治的SAA合并胆总管结石患者的数据库进行回顾性研究。他们均在ERCP失败后接受了单次EUS-TASR。收集患者的基本特征和手术细节。对成功率和不良事件进行评估和讨论。
在研究期间，13例患者接受了简化的单次EUS-TASR作为补救措施（8例男性，中位年龄64.0[四分位间距，48.5 - 69.5]岁）。SAA包括4例惠普尔手术、1例毕罗Ⅱ式胃切除术、4例胃切除加 Roux-en-Y吻合术和4例肝空肠吻合加 Roux-en-Y吻合术。技术成功率为100%，12例患者（92.3%）成功取出胆管结石。2例患者（15.4 %）发生不良事件，1例转为腹腔镜手术，另1例保守治疗。
ERCP失败后简化的单次EUS-TASR作为补救措施，在治疗SAA患者胆总管结石方面似乎是有效和安全的。但仍需要对该技术进行进一步评估，最好通过前瞻性多中心试验进行。
