Mauro Aurelio, Vanella Giuseppe, Mirante Vincenzo Giorgio, Fugazza Alessandro, Binda Cecilia, Elli Luca, Forti Edoardo, Di Mitri Roberto, Berretti Debora, Bertani Helga, Delliponti Mariangela, Desideri Federico, Ferretti Virginia, Grassia Roberto, Leone Roberto, Manno Mauro, Mazza Stefano, Mussetto Alessandro, Pessarelli Tommaso, Rizzo Giacomo Emanuele Maria, Spadaccini Marco, Tarantino Ilaria, Fabbri Carlo, Anderloni Andrea
Gastroenterology and Digestive Endoscopy Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, Pavia, Italy.
Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Gastrointest Endosc. 2025 Apr 25. doi: 10.1016/j.gie.2025.04.032.
Endoscopic biliary drainage (BD) in patients with surgical altered anatomy (SAA) is a challenging scenario. Different BD approaches are available but still not standardized, and they rely on local availability and expertise. The aim of this study was to explore the approach to BD in patients with SAA in different centers.
This was a retrospective multicenter cohort study. All adult patients with SAA who underwent endoscopic BD for any indication in the last 5 years were enrolled. Clinical outcomes were evaluated according to the type of surgical reconstruction, the clinical indication, and the type of endoscopic BD technique used.
A total of 432 patients were included. Global technical and clinal success of BD was 80.3% and 79.9%, respectively. Outcomes were similar among the different types of surgical reconstruction except for a higher rate of adverse events in patients with Billroth-II reconstruction (14.4%). BD approach in patients with Roux-en-Y reconstruction was heterogeneous with a higher use of more advanced procedures such as device-assisted enteroscopy ERCP and interventional EUS. Interventional EUS procedures were more frequently performed in the last 2-year period showing a higher probability of clinical success (odds ratio, 7.87; 95% CI, 2.56-24.13; P < .001) than the other BD techniques with lower rate of reintervention in the follow-up period.
BD in patients with SAA is still associated with suboptimal chance of success in all the different types of reconstruction. The increasing use of interventional EUS procedures in the last years significantly improved outcomes in patients with SAA treated with these techniques.
手术解剖结构改变（SAA）患者的内镜下胆道引流（BD）是一个具有挑战性的情况。有多种不同的BD方法，但仍未标准化，且这些方法依赖于当地的可获得性和专业知识。本研究的目的是探讨不同中心SAA患者的BD方法。
这是一项回顾性多中心队列研究。纳入了过去5年中因任何适应证接受内镜下BD的所有成年SAA患者。根据手术重建类型、临床适应证和所使用的内镜BD技术类型评估临床结局。
共纳入432例患者。BD的总体技术成功率和临床成功率分别为80.3%和79.9%。除毕罗Ⅱ式重建患者不良事件发生率较高（14.4%）外，不同类型手术重建的结局相似。Roux-en-Y重建患者的BD方法存在异质性，更多地使用了如器械辅助小肠镜检查ERCP和介入性超声内镜等更先进的操作。介入性超声内镜操作在过去2年中更频繁地进行，与其他BD技术相比，临床成功的可能性更高（优势比，7.87；95%CI，2.56 - 24.13；P <.001），且随访期再次干预率较低。
SAA患者的BD在所有不同类型的重建中成功率仍不理想。近年来介入性超声内镜操作的使用增加显著改善了接受这些技术治疗的SAA患者的结局。
