一项针对解剖结构改变患者恶性梗阻，采用球囊内镜和内镜超声进行胆道引流的回顾性对比研究。
A retrospective comparative study of biliary drainage using balloon endoscopy and endoscopic ultrasound for malignant obstruction in patients with surgically altered anatomy.
作者信息
Hakuta Ryunosuke, Ishida Kota, Nakai Yousuke, Kogure Hirofumi, Nishio Hiroto, Kurihara Kouhei, Tange Shuichi, Fukuda Rintaro, Takaoka Shinya, Suzuki Yukari, Oyama Hiroki, Kanai Sachiko, Noguchi Kensaku, Suzuki Tatsunori, Sato Tatsuya, Ishigaki Kazunaga, Saito Tomotaka, Hamada Tsuyoshi, Takahara Naminatsu, Fujishiro Mitsuhiro
机构信息
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Endoscopy and Endoscopic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
出版信息
Surg Endosc. 2024 Dec;38(12):7269-7277. doi: 10.1007/s00464-024-11329-1. Epub 2024 Oct 14.
BACKGROUND AND AIMS
Endoscopic biliary drainage for malignant biliary obstruction (MBO) in patients with surgically altered anatomy is challenging, and technical difficulty could differ by the anatomy. Balloon endoscopy-assisted endoscopic retrograde cholangiopancreatography (BE-ERCP) and endoscopic ultrasonography-guided biliary drainage (EUS-BD) are both emerging procedures, and we conducted the single-center, retrospective study to compare clinical outcomes of BE-ERCP and EUS-BD for MBO.
METHODS
Consecutive patients with surgically altered anatomy who underwent BE-ERCP or EUS-BD for MBO were retrospectively studies. Technical and clinical success rates, adverse events (AEs), and time to recurrent biliary obstruction (TRBO) were compared.
RESULTS
Patient characteristics were comparable between BE-ERCP (n = 118) and EUS-BD (n = 32), other than more patients with hepaticojejunostomy in the BE-ERCP group (66% vs. 44%, P = 0.03). Technical success rate was significantly higher in the EUS-BD group (70% vs. 94%, P = 0.005), but clinical success rates (84% vs. 90%, P = 0.55), early AE (14% vs. 22%, P = 0.29) and late AE rates (42% vs. 38%, P = 0.84), and RBO rates (31% vs. 34%, P = 0.67) were comparable between the groups. TRBO was 170 and 206 days in the BE-ERCP and EUS-BD group (P = 0.37). In the subgroup analysis of patients with the intact papilla, the technical success rate of BE-ERCP was as low as 55%, compared to 94% in EUS-BD (P = 0.003).
CONCLUSION
EUS-BD was associated with higher technical success rate than BE-ERCP for MBO in patients with surgically altered anatomy.
背景与目的
对于解剖结构已手术改变的恶性胆管梗阻（MBO）患者，内镜下胆道引流具有挑战性，且技术难度可能因解剖结构而异。气囊内镜辅助内镜逆行胰胆管造影（BE-ERCP）和内镜超声引导下胆道引流（EUS-BD）都是新兴的操作，我们进行了这项单中心回顾性研究，以比较BE-ERCP和EUS-BD治疗MBO的临床结局。
方法
对因MBO接受BE-ERCP或EUS-BD且解剖结构已手术改变的连续患者进行回顾性研究。比较技术成功率、临床成功率、不良事件（AE）以及胆道梗阻复发时间（TRBO）。
结果
BE-ERCP组（n = 118）和EUS-BD组（n = 32）的患者特征具有可比性，但BE-ERCP组肝空肠吻合术患者更多（66%对44%，P = 0.03）。EUS-BD组的技术成功率显著更高（70%对94%，P = 0.005），但两组的临床成功率（84%对90%，P = 0.55）、早期AE发生率（14%对22%，P = 0.29）和晚期AE发生率（42%对38%，P = 0.84）以及RBO发生率（31%对34%，P = 0.67）相当。BE-ERCP组和EUS-BD组的TRBO分别为170天和206天（P = 0.37）。在乳头完整患者的亚组分析中，BE-ERCP的技术成功率低至55%，而EUS-BD为94%（P = 0.003）。
结论
对于解剖结构已手术改变的MBO患者，EUS-BD的技术成功率高于BE-ERCP。
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