Chieng Michael, Fox Tara, Chin Jerry Yung-Lun, Johns Estella, Cameron Rees, Weilert Frank
Gastroenterology, Waikato District Health Board, Hamilton, New Zealand.
Gastroenterology, Wellington Regional Hospital, Newtown, New Zealand.
Endosc Int Open. 2025 Jul 23;13:a26317857. doi: 10.1055/a-2631-7857. eCollection 2025.
Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is described as salvage therapy for patients with distal malignant biliary obstruction (DMBO). However, there is a paucity of data reporting on clinical outcomes for this indication.
A multicenter retrospective review of 26 EUS-GBD cases was performed between 2017 and 2023 at two centers in New Zealand. Efficacy outcomes of technical success (TS), clinical success (CS), length of stay (LOS), and resumption of cancer therapy were recorded. Adverse events (AEs), reinterventions, time to reintervention, and survival also were examined. Reinterventions were categorized into early (< 7 days) or delayed procedures (≥ 7 days).
Mean age was 74 years. Pancreatic cancer was the most common diagnosis. All included cases were unresectable and eight of 26 (30.8%) were chemotherapy candidates. TS and CS were achieved in all patients. At 14 days, bilirubin decreased from a mean of 139 to 55 μmol/L, a 60.4% reduction from baseline value. Mean LOS was 3 days. Of eligible patients, 87.5% were able to resume chemotherapy post-procedure. There were no intra-procedural complications nor early reinterventions. Four serious AEs (15.4%) required reintervention; the remaining nine were treated conservatively. Median survival was 103 days.
EUS-GBD is a clinically effective salvage therapy for DMBO that may be positioned after unsuccessful endoscopic retrograde cholangiopancreatography or EUS-BD in a single anesthetic session. Most patients have a short LOS and few serious AEs. Furthermore, oncologic therapy can be successfully resumed post-procedure. EUS-GBD, therefore, should be considered an effective, safe, and durable addition to the treatment armamentarium for DMBO.
内镜超声引导下胆囊引流术（EUS-GBD）被描述为远端恶性胆管梗阻（DMBO）患者的挽救性治疗方法。然而，关于该适应症临床结局的数据报道较少。
对2017年至2023年期间新西兰两个中心的26例EUS-GBD病例进行了多中心回顾性研究。记录了技术成功（TS）、临床成功（CS）、住院时间（LOS）和癌症治疗恢复情况等疗效指标。还检查了不良事件（AE）、再次干预、再次干预时间和生存率。再次干预分为早期（<7天）或延迟手术（≥7天）。
平均年龄为74岁。胰腺癌是最常见的诊断。所有纳入病例均不可切除，26例中有8例（30.8%）适合化疗。所有患者均实现了TS和CS。在14天时，胆红素从平均139 μmol/L降至55 μmol/L，较基线值降低了60.4%。平均LOS为3天。符合条件的患者中，87.5%在术后能够恢复化疗。术中无并发症，也无早期再次干预。4例严重AE（15.4%）需要再次干预；其余9例采用保守治疗。中位生存期为103天。
EUS-GBD是一种临床有效的DMBO挽救性治疗方法，可在内镜逆行胰胆管造影术或EUS-BD单次麻醉失败后进行。大多数患者住院时间短，严重AE少。此外，术后可成功恢复肿瘤治疗。因此，EUS-GBD应被视为DMBO治疗手段中一种有效、安全且持久的补充方法。
