时间:2018-08-20 作者:翻译:于廷廷 审校 点击:

虽然气囊小肠镜辅助ERCP(BE-ERCP)对于手术后解剖结构改变的(SAA)患者的良性胆道疾病是有效且安全的,但BE-ERCP并不总能成功实施。 最近,针对BE-ERCP失败病例,进行了EUS引导下的干预治疗(EUS-AI),包括1期或2期。 本研究的目的是评估EUS-AI治疗SAA患者良性胆道疾病的疗效。
方法:本文回顾性分析了2013年11月至2017年11月期间行BE-ERCP失败的48名良性胆道疾病患者,其中11名患者进行了经皮经肝穿刺干预治疗, 另有37例接受了EUS-AI治疗 [胆总管结石(n = 11),肝内胆管结石(n = 5),吻合口狭窄(n = 21)] 。
结果:EUS建立肝肠通道的总体技术成功率为91.9%(34/37)。中度不良事件发生率为8.1%(胆汁性腹膜炎[n = 3])。 通过EUS的一期EUS-AI在8例(100%)中成功,没有任何不良事件。另有26例通过2期行ERCP,在EUS-AI后大约1或2个月后进行。透视下内镜顺行治疗成功6例。 19例患者需要经口胆道镜辅助干预(穿过狭窄吻合口的导丝操作[n = 6],在胆管镜引导下进行液电碎石术[n = 13])。 还有1例行磁性压迫吻合术。 所有EUS-AI的最终临床成功率为91.9%。

EUS-guided antegrade intervention for benign biliary diseases in patients with surgically altered anatomy 
Mukai, S., T. Itoi, A. Sofuni, et al.. Gastrointest Endosc  (Aug 1 2018).
BACKGROUND AND AIMS:Although balloon enteroscopy-assisted ERCP (BE-ERCP) is effective and safe for benign biliary diseases in patients with surgically altered anatomy (SAA), BE-ERCP is not always successful. Recently, EUS-guided antegrade intervention (EUS-AI) including a 1-stage or 2-stage procedure has been developed for BE-ERCP failure cases. The aim of the present study was to evaluate the outcome of EUS-AI for benign biliary diseases with SAA
METHODS:Of 48 patients in whom BE-ERCP failed, percutaneous transhepatic intervention was performed in 11 patients. Another 37 patients who failed BE-ERCP and underwent EUS-AI for benign biliary diseases with SAA [common bile duct stones (n = 11), intrahepatic bile duct stones (n = 5), anastomotic stricture (n = 21)] from November 2013 until November 2017 were retrospectively reviewed.
RESULTS:The overall technical success of the creation of hepaticoenteric tract by EUS was 91.9% (34/37). Moderate adverse events were observed in 8.1% (biliary peritonitis [n=3]). One-stage EUS-AI by EUS succeeded in 8 cases (100%) without any adverse events. In another 26 cases, 2-stage EUS-AI by ERCP was performed about 1 or 2 months later. Endoscopic antegrade therapy under fluoroscopy was successful in 6 cases. Per-oral cholangioscopy-assisted antegrade intervention were required in 19 cases (guidewire manipulation across the anastomotic stricture [n=6], cholangioscopy-guided lithotripsy using electrohydraulic lithotripsy [n=13]). In 1 case, magnetic compression anastomosis was performed. The final clinical success rate of all EUS-AI was 91.9%.
CONCLUSIONS:EUS-AI for benign biliary diseases with SAA appears to be a feasible and safe alternative procedure after BE-ERCP failure.

翻译:于廷廷   审校:张立超、侯森林