Wang Duan, Zhu Liang, Kong Fanyi, Pan Yingyu, Liu Wei, Wang Xuan, Pan Weidong, Cao Jian, Xu Qiang, Wu Dong
Department of Gastroenterology, Peking Union Medical College Hospital, Beijing, China.
Department of Gastroenterology, Tibet Autonomous Region People's Hospital, Lhasa, China.
Front Med (Lausanne). 2025 Feb 12;12:1485442. doi: 10.3389/fmed.2025.1485442. eCollection 2025.
Endoscopic retrograde cholangiopancreatography (ERCP) is a useful diagnostic and interventional tool in patients with obstructive jaundice. In patients who had subtotal gastrectomy, however, the implementation of ERCP has become more difficult. This study aims to investigate the accuracy of contrast-enhanced CT, MRI/MRCP and PET/CT in lesion localization, characterization, and extent evaluation in post-subtotal gastrectomy patients who present with obstructive jaundice. The interventional methods for biliary drainage, their success rate and patient outcome were also investigated.
Electronic medical records were reviewed to identify patients hospitalized for obstructive jaundice at Peking Union Medical College Hospital, who had previously undergone subtotal gastrectomy. The clinical information, imaging and interventional examination data of those patients were retrospectively collected.
Between 2018 and 2023, 36 patients with previous subtotal gastrectomy were hospitalized for ob-structive jaundice at our hospital. The majority of lesions were malignant, including 19 gastric cancer recurrence (47.5%), and 12 other malignancies (30.0%). Benign lesions included inflammatory biliary stricture, biliary stones, and IgG4-related disease. The three imaging modalities had similar performance in lesion localization and characterization, whereas PET/CT showed higher accuracy compared to MR and CT in detecting extensive disease (92.8% vs. 83.3% vs. 60.0%). Percutaneous transhepatic cholangial drainage was applied more frequently than ERCP and surgery (69.4% vs. 25.0% vs. 5.5%), and there was no significant difference concerning technical and clini-cal success rate and complication.
Gastric cancer recurrence and newly-developed pancreaticobiliary malignancies were the main causes of obstructive jaundice in patients who had subtotal gastrectomy. PET/CT was superior to MRI/MRCP and contrast-enhanced CT in determining lesion extensiveness. Percutaneous transhepatic cholangial drainage (PTCD) was the preferred method for managing obstructive jaundice. Despite the effectiveness of interventions, a significant number of patients experienced short-term disease progression.
内镜逆行胰胆管造影术（ERCP）是梗阻性黄疸患者有用的诊断和介入工具。然而，对于接受过胃大部切除术的患者，ERCP的实施变得更加困难。本研究旨在探讨对比增强CT、MRI/MRCP和PET/CT在胃大部切除术后出现梗阻性黄疸患者的病变定位、特征描述及范围评估中的准确性。同时也研究了胆道引流的介入方法、成功率及患者预后。
回顾电子病历，以确定在北京协和医院因梗阻性黄疸住院且先前接受过胃大部切除术的患者。回顾性收集这些患者的临床信息、影像学和介入检查数据。
2018年至2023年期间，我院有36例先前接受过胃大部切除术的患者因梗阻性黄疸住院。大多数病变为恶性，包括19例胃癌复发（47.5%）和12例其他恶性肿瘤（30.0%）。良性病变包括炎性胆管狭窄、胆结石和IgG4相关疾病。三种影像学检查在病变定位和特征描述方面表现相似，而PET/CT在检测广泛病变方面显示出比MR和CT更高的准确性（92.8%对83.3%对60.0%）。经皮经肝胆管引流术的应用频率高于ERCP和手术（69.4%对25.0%对5.5%），在技术成功率、临床成功率及并发症方面无显著差异。
胃癌复发和新发生的胰胆恶性肿瘤是胃大部切除术后患者梗阻性黄疸的主要原因。PET/CT在确定病变范围方面优于MRI/MRCP和对比增强CT。经皮经肝胆管引流术（PTCD）是处理梗阻性黄疸的首选方法。尽管干预措施有效，但仍有相当数量的患者出现短期疾病进展。
