30例患者均为肝外胆道恶性梗阻（19名男性，11名女性）。 27例患者为不可切除的胰腺导管腺癌，1例患者患有胆总管远端癌，2例患者有转移性恶性淋巴结肿大。 在技术成功率和临床成功率方面没有显着差异（ERCP-BD与EUS-BD分别为100％vs 93％和93％vs 100％; P =1.00，P=1.00）。 ERCP-BD组中有4名患者（31％）出现肿瘤向支架内生长导致的支架功能障碍，而EUS-BD组有2名患者有食物堵塞，2名患者有支架移位。 两组均未发生明显的手术相关不良事件。
Efficacy of EUS-guided and ERCP-guided biliary drainage for malignant biliary obstruction prospective randomized controlled study
JK Park, YS Woo, HN Dong et al. GASTROINTESTINAL ENDOSCOPY Volume 88, No. 2: 2018
Background and Aims:
ERCP-guided biliary drainage (ERCP-BD) is a criterion standard treatment for malignant biliary obstruction when curative surgery is not an option. Alternative methods such as percutaneous transhepatic biliary drainage would significantly lower the quality of life. EUS-guided biliary drainage (EUS-BD) has been developed and performed by experienced endoscopists. Therefore, the aims of this study were to evaluate the efficacy and safety of EUS-BD compared with ERCP in malignant biliary obstruction.
The prospective randomized controlled study was conducted, and 30 patients were enrolled: 15 for each EUS-BD and ERCP-BD arms. The technical success, procedural time, clinical success, and adverse events were evaluated.
Thirty patients had extrahepatic malignant biliary tract obstruction (19 men, 11 women). Twenty-seven patients had unresectable pancreatic ductal adenocarcinomas, 1 patient had distal common bile duct cancer, and 2 patients had metastatic malignant lymphadenopathy. There were no significant differences both in terms of technical success rate and clinical success rate (100% vs 93% and 93% vs 100% in ERCP-BD vs EUS-BD, respectively; P=1.00, P=1.00). Four patients (31%) had tumor ingrowth–caused stent dysfunction in the ERCP-BD group, whereas 2 patients had food impaction and 2 patients had stent migration in the EUS-BD group. No significant procedure-related adverse events occurred in either group.
This prospective randomized controlled study suggests that EUS-BD has similar safety to ERCP-BD.EUS-BD was not superior to ERCP-BD in terms of relief of malignant biliary obstruction. EUS-BD may have fewer cases of tumor ingrowth but may also have more cases of food impaction or stent migration.
翻译： 于廷廷 审校：张立超、侯森林 （GASTROINTESTINAL ENDOSCOPY 2018）