Single-session endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography for evaluation of pancreaticobiliary disorders
Single-session endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography for evaluation of pancreaticobiliary disorders
复制标题
DOI：
10.1007/s00464-009-0798-3
复制
发表时间：
2010-06-01
影响因子：
3.1
通讯作者：
Levi, Joe U.
中科院分区：
文献类型：
--
作者：
Ascunce, Gil;Ribeiro, Afonso;Levi, Joe U.
在评估和治疗胰胆管疾病时，通常需要进行超声内窥镜检查(EUS)和逆行胰胆管造影术(ERCP)。很少有关于单次EUS-ERCP的报告对其安全性和准确性提出质疑，或者关于应该首先进行哪种手术的问题。2005年至2009年的数据来自一个单一三级护理癌症中心前瞻性维护的EUS-ERCP数据库。评估EUS和细针吸取(FNA)的敏感性和特异性、胆管插管率、手术时间和并发症。在35例患者(男性15例，女性20例)中，28例最终诊断为恶性肿瘤，7例为良性疾病。所有患者均行ERCP和EUS检查，其中28例(80%)行FNA检查。对于35名患者中的22名(62.8%)，EUS是第一次进行的手术。EUS-FNA对恶性病变的敏感性为96.4%。ERCP胆管插管率为97.1%。5名患者需要预先切开括约肌以进入胆道，1名慢性胰腺炎患者尽管在EUS引导下会合，但插管失败。29例(96%)患者支架置入成功。未发生重大并发症，在胆道造影术前行FNA检查，未见造影剂渗漏。1例FNA术后十二指肠周围出血，经保守治疗。平均手术时间83.7min，单次EUS-ERCP手术安全有效，与单独手术疗效相当。
Endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) often are required in the evaluation and treatment of patients with pancreaticobiliary disorders. Few reports of single-session EUS-ERCP have raised questions regarding its safety and accuracy or about which procedure should be performed first.Data from 2005 to 2009 were reviewed from a prospectively maintained EUS-ERCP database at a single tertiary care cancer center. Sensitivity and specificity of EUS and fine-needle aspiration (FNA), bile duct cannulation rate, duration of procedure, and complications were evaluated.Of the 35 patients (15 men and 20 women) studied, 28 had a final diagnosis of malignancy, and 7 had benign disorders. All the patients underwent ERCP and EUS, with FNA performed for 28 patients (80%). For 22 of the 35 patients (62.8%), EUS was the first procedure performed. The sensitivity of EUS-FNA for malignancy was 96.4%. The bile duct cannulation rate during ERCP was 97.1%. Five patients required a precut sphincterotomy for bile duct access, and one patient with chronic pancreatitis had a failed cannulation despite a EUS-guided rendezvous. A stent was successfully placed in 29 patients (96%). No major complications occurred, and no contrast leak was seen when FNA was performed before the cholangiogram. One patient had periduodenal bleeding after FNA, which was managed conservatively. The mean duration of the procedure was 83.7 min.Single-session EUS-ERCP can be performed safely and with efficacy similar to that of the procedures performed separately.