Ishiwatari Hirotoshi, Kaneko Junichi, Sato Junya, Satoh Tatsunori, Ishikawa Kazuma, Niiya Fumitaka, Matsubayashi Hiroyuki, Minamide Tatsunori, Maeda Yuki, Yamamoto Youichi, Kishida Yoshihiro, Yoshida Masao, Ito Sayo, Kawata Noboru, Imai Kenichiro, Hotta Kinichi, Imamura Taisuke, Sugiura Teiichi, Uesaka Katsuhiko, Ono Hiroyuki
Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan.
Division of Gastroenterology, Iwata City Hospital, Shizuoka, Japan.
Endosc Ultrasound. 2024 Jan-Feb;13(1):28-34. doi: 10.1097/eus.0000000000000027. Epub 2023 Nov 3.
Endoscopic treatment of obstructive jaundice and pancreatitis due to hepaticojejunostomy (H-J), pancreatojejunostomy (P-J) strictures, and tumor recurrence after pancreatoduodenectomy (PD) is technically challenging. Treatment of P-J strictures results in poor outcomes. Although conventional EUS that has an oblique view is not suitable for such patients, forward-viewing EUS (FV-EUS) may become a useful option. This study aimed to evaluate the feasibility and efficacy of FV-EUS in patients who have undergone PD.
Patients with PD who were scheduled to undergo diagnosis and treatment using FV-EUS for H-J or P-J lesions were enrolled in this single-center prospective study. After observation of the P-J and H-J using FV-EUS according to a predetermined protocol, treatment using FV-EUS was performed as needed.
A total of 30 patients were enrolled, and FV-EUS was used to observe P-J and H-J in 24 and 28 patients, respectively. The detection rates of P-J and H-J by endoscopy were 50% (12/24) and 96.4% (27/28), respectively, and by EUS were 70.8% (17/24) and 100% (28/28), respectively. Of these, P-J and H-J were found by endoscopy only after EUS observation in 3 and 1 patient, respectively. The success rates of endoscopic treatment using FV-EUS were 66.7% (2/3), 95.2% (20/21), and 25% (1/4) for benign P-J strictures, benign H-J strictures, and tumor recurrence, respectively.
Endoscopic treatment using FV-EUS is feasible and effective for patients after PD. Moreover, FV-EUS increases the P-J lesion detection rate by adding EUS observation.
内镜治疗肝空肠吻合术（H-J）、胰空肠吻合术（P-J）狭窄以及胰十二指肠切除术（PD）后肿瘤复发所致的梗阻性黄疸和胰腺炎在技术上具有挑战性。P-J狭窄的治疗效果不佳。尽管具有斜视图的传统超声内镜不适合此类患者，但前视超声内镜（FV-EUS）可能成为一种有用的选择。本研究旨在评估FV-EUS在接受PD患者中的可行性和疗效。
计划使用FV-EUS对H-J或P-J病变进行诊断和治疗的PD患者纳入本单中心前瞻性研究。根据预定方案使用FV-EUS观察P-J和H-J后，根据需要进行FV-EUS治疗。
共纳入30例患者，分别使用FV-EUS观察了24例患者的P-J和28例患者的H-J。内镜检查对P-J和H-J的检出率分别为50%（12/24）和96.4%（27/28），超声内镜检查的检出率分别为70.8%（17/24）和100%（28/28）。其中，分别有3例和1例患者仅在超声内镜观察后经内镜检查发现P-J和H-J。FV-EUS内镜治疗良性P-J狭窄、良性H-J狭窄和肿瘤复发的成功率分别为66.7%（2/3）、95.2%（20/21）和25%（1/4）。
FV-EUS内镜治疗对PD术后患者可行且有效。此外，FV-EUS通过增加超声内镜观察提高了P-J病变的检出率。
