Department of Gastroenterology and Hepatology with Internal Disease Unit, Specialist University Hospital Frederic Chopin in Rzeszow, Rzeszow, Poland.
Medical Department, University of Rzeszów, Rzeszów, Poland.
J Palliat Med. 2024 Nov;27(11):1475-1481. doi: 10.1089/jpm.2024.0084. Epub 2024 Aug 2.
Endosonography-guided biliary drainage (EUS-BD) serves as a rescue treatment modality for patients with malignant biliary obstruction when endoscopic retrograde cholangiopancreatography (ERCP) fails. This study explores the effects of EUS-BD on liver function and quality of life (QoL). Patients with malignant biliary obstruction and failed ERCP were enrolled to undergo EUS-BD. QoL, including pruritus severity, was evaluated using EQ-5D-5L and PSS-10 questionnaires before and after EUS-BD. Serum bilirubin and liver function tests were measured on the procedure day, two days, and at least 14 days post-procedure. During a 20-month study period, 1755 ERCPs were performed, with 595 for malignant cases. Of these, 49 underwent EUS-BD following failed ERCP, and 37 (54% women, age range 34-87 years) completed the 14-day follow-up. Pancreatic cancer was the most common (49%) condition, and the median hospital stay was 4 days. Serum bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and gamma-glutamyl transferase significantly decreased 2 and 14 days after EUS-BD (all < 0.001). Pruritus significantly improved, with an average reduction of 5.19 points on the PSS-10 scale two weeks post-procedure ( < 0.001). EUS-BD led to improvements in anxiety and depression according to the EQ-5D-5L ( = 0.013). Conversely, deteriorations were observed in the Mobility, Self-Care, and Usual Activities domains over time (all < 0.05). Successful EUS-BD enabled the resumption of chemotherapy in 11 (30%) patients. The median post-procedure survival was 112 (range 27-1030) days. EUS-BD improves liver parameters and some aspects of life quality in patients with malignant biliary obstruction, thereby increasing their eligibility for optimal palliative care.
超声内镜引导下胆道引流术（EUS-BD）是内镜逆行胰胆管造影术（ERCP）失败后治疗恶性胆道梗阻的一种抢救治疗方法。本研究探讨了 EUS-BD 对肝功能和生活质量（QoL）的影响。入组的恶性胆道梗阻且 ERCP 失败的患者接受 EUS-BD。在 EUS-BD 前后，使用 EQ-5D-5L 和 PSS-10 问卷评估 QoL，包括瘙痒严重程度。在手术当天、两天和至少术后 14 天测量血清胆红素和肝功能检查。在 20 个月的研究期间，进行了 1755 次 ERCP，其中 595 次用于恶性病例。其中，49 例在 ERCP 失败后行 EUS-BD，37 例（54%为女性，年龄 34-87 岁）完成了 14 天的随访。最常见的疾病是胰腺癌（49%），中位住院时间为 4 天。EUS-BD 后 2 天和 14 天，血清胆红素、丙氨酸转氨酶、天冬氨酸转氨酶、碱性磷酸酶和γ-谷氨酰转移酶显著下降（均<0.001）。瘙痒明显改善，术后两周 PSS-10 评分平均降低 5.19 分（<0.001）。EUS-BD 根据 EQ-5D-5L 改善焦虑和抑郁（=0.013）。相反，随着时间的推移，移动性、自我护理和日常活动领域的恶化（均<0.05）。11 例（30%）患者的 EUS-BD 成功后，重新开始化疗。术后中位生存时间为 112（范围 27-1030）天。EUS-BD 可改善恶性胆道梗阻患者的肝功能参数和生活质量的某些方面，从而提高他们接受最佳姑息治疗的资格。
