Takahashi Sho, Matsubara Saburo, Fujisawa Toshio, Otsuka Takeshi, Suda Kentaro, Ushio Mako, Fukuma Taito, Suzuki Akinori, Takasaki Yusuke, Ito Koichi, Tomishima Ko, Ishii Shigeto, Nagoshi Sumiko, Isayama Hiroyuki
Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan.
Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Hidaka, Japan.
Endosc Ultrasound. 2025 Jan-Feb;14(1):20-25. doi: 10.1097/eus.0000000000000099. Epub 2025 Feb 25.
Recent technological advances in interventional EUS have improved EUS-guided drainage/anastomosis (EUS-D/A), yet challenges remain. This study evaluated the safety and feasibility of a square flare fully covered self-expandable metallic stent (SF-FCSEMS) with anti-migration properties for EUS-D/A.
This retrospective cohort study was performed at 2 academic centers and analyzed patients who underwent SF-FCSEMS placement for EUS-D/A from April 2015 to November 2022. We have used an SF-FCSEMS that has a square flare at both ends that is 4 mm larger in diameter than the stent body, providing an anti-migration effect.
Thirty-six patients (median age: 74 years), 41.6% male, were included. Malignancies accounted for 83.3%. Among the EUS-D/A procedure types, EUS-abscess drainage was performed in 52.8%, EUS-guided gallbladder drainage in 30.6%, and EUS-guided abscess drainage in 16.7%. The technical success rate was 97.2%, and the clinical success rate was 97.1%. The median procedure time was 36 minutes, with puncture tract dilation conducted in all cases. Adverse events occurred in 11.1%; recurrent symptoms were observed in 11.8%, with no migration. SF-FCSEMS removal was performed in 26.5% of patients during the follow-up period, with a median duration of 154 days. The total cost of deploying SF-FCSEMS was approximately 40% less than that of using lumen apposing metal stent.
EUS-D/A with an SF-FCSEMS, which has anti-migration properties, not only was effective and feasible in the present study but also demonstrated a cost advantage.
介入性超声内镜的最新技术进展改善了超声内镜引导下的引流/吻合术（EUS-D/A），但挑战依然存在。本研究评估了具有抗迁移特性的方形喇叭口全覆膜自膨式金属支架（SF-FCSEMS）用于EUS-D/A的安全性和可行性。
本回顾性队列研究在2个学术中心进行，分析了2015年4月至2022年11月期间接受SF-FCSEMS置入术以进行EUS-D/A的患者。我们使用的SF-FCSEMS两端有方形喇叭口，其直径比支架主体大4毫米，具有抗迁移作用。
共纳入36例患者（中位年龄：74岁），男性占41.6%。恶性肿瘤占83.3%。在EUS-D/A手术类型中，52.8%为超声内镜引导下脓肿引流，30.6%为超声内镜引导下胆囊引流，16.7%为超声内镜引导下胆管引流。技术成功率为97.2%，临床成功率为97.1%。中位手术时间为36分钟，所有病例均进行了穿刺通道扩张。不良事件发生率为11.1%；11.8%观察到复发症状，但无迁移。26.5%的患者在随访期间进行了SF-FCSEMS取出，中位持续时间为154天。部署SF-FCSEMS的总成本比使用管腔贴附金属支架低约40%。
具有抗迁移特性的SF-FCSEMS用于EUS-D/A，不仅在本研究中有效且可行，还显示出成本优势。
