使用新型金属支架作为一线治疗手段进行超声内镜引导下右肝叶肝脓肿引流的技术可行性（附视频）
Technical feasibility of EUS-guided liver abscess drainage for the right hepatic lobe using a novel metal stent as first-line treatment (with video).
作者信息
Ogura Takeshi, Ueno Saori, Okuda Atsushi, Nishioka Nobu, Sakamoto Jun, Yamada Masanori, Yamamura Masahiro, Uba Yuki, Tomita Mitsuki, Hattori Nobuhiro, Nakamura Junichi, Bessho Kimi, Nishikawa Hiroki
机构信息
Endoscopy Center, Osaka Medical and Pharmaceutical University, Osaka, Japan; 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan.
2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan.
出版信息
Gastrointest Endosc. 2025 Jun;101(6):1250-1257. doi: 10.1016/j.gie.2024.09.013. Epub 2024 Sep 12.
BACKGROUND AND AIMS
Although EUS-guided liver abscess drainage (EUS-LAD) has been developed, only the left hepatic or caudate lobe can traditionally be drained by EUS. However, there is no evidence for the technical feasibility of EUS-LAD for the right hepatic lobe. In this retrospective study, the technical feasibility of EUS-LAD using a novel partially covered self-expandable metal stent (PCSEMS) with an antimigration system was evaluated as a first-line drainage technique for right hepatic lobe abscesses.
METHODS
This study included consecutive patients with right lobe liver abscesses between December 2020 and February 2024. The primary outcome in this study was the technical success rate of EUS-LAD. Technical success of EUS-LAD was defined as successful stent deployment from the liver abscess to the duodenum. Clinical success, procedure time, duration of hospital stay, recurrence of liver abscess, and adverse events were evaluated as secondary outcomes.
RESULTS
Nineteen patients were enrolled in this study. The location of the liver abscesses was mainly at segment 6. The mean size of the liver abscesses was 91.8 mm. The liver abscess could be identified under EUS guidance from the duodenum in 16 patients. Puncture using a 19-gauge needle was attempted, but the needle could not reach the liver abscess in 1 patient. The novel PCSEMS was successfully deployed in all patients. The technical success rate of EUS-LAD was 78.9% (15/19). Adverse events associated with the procedure were observed in 3 patients, but conservative treatment was successful. Clinical success was obtained in 14 patients (93.3%). The median duration of stent placement was 19 days (range, 7-41). The median follow-up period was 556 days, and recurrence of liver abscess was not observed in any patients.
CONCLUSIONS
EUS-LAD for the right liver lobe using a novel PCSEMS can be feasible and safe.
背景与目的
尽管超声内镜引导下肝脓肿引流术（EUS-LAD）已得到发展，但传统上EUS仅能对左肝叶或尾状叶进行引流。然而，尚无证据表明EUS-LAD对右肝叶具有技术可行性。在这项回顾性研究中，评估了使用带有防移位系统的新型部分覆膜自膨式金属支架（PCSEMS）进行EUS-LAD作为右肝叶脓肿一线引流技术的技术可行性。
方法
本研究纳入了2020年12月至2024年2月期间连续的右叶肝脓肿患者。本研究的主要结局是EUS-LAD的技术成功率。EUS-LAD的技术成功定义为将支架从肝脓肿成功置入十二指肠。临床成功率、手术时间、住院时间、肝脓肿复发情况及不良事件作为次要结局进行评估。
结果
本研究共纳入19例患者。肝脓肿主要位于6段。肝脓肿的平均大小为91.8毫米。16例患者在超声内镜引导下可从十二指肠识别出肝脓肿。尝试使用19G穿刺针穿刺，但1例患者穿刺针未能到达肝脓肿。所有患者均成功置入新型PCSEMS。EUS-LAD的技术成功率为78.9%（15/19）。3例患者观察到与手术相关的不良事件，但保守治疗成功。14例患者（93.3%）获得临床成功。支架置入的中位时间为19天（范围7-41天）。中位随访期为556天，所有患者均未观察到肝脓肿复发。
结论
使用新型PCSEMS进行右肝叶EUS-LAD可行且安全。
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