Interventional EUS-guided cholangiography: evaluation of a technique in evolution
Interventional EUS-guided cholangiography: evaluation of a technique in evolution
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DOI：
10.1016/j.gie.2006.01.063
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发表时间：
2006-07-01
影响因子：
7.7
通讯作者：
Yeaton, P
中科院分区：
文献类型：
--
作者：
Kahaleh, M;Hernandez, AJ;Yeaton, P
工作背景：在ERCP不成功的胆道梗阻病例中，介入性EUS引导胆管造影术（IEUC）越来越多地被用作经皮经肝胆管胆管造影术（PTC）的替代方法。目的：我们回顾了我们用于该手术的经验和技术。设计：在截至2005年7月的3年期间，为ERCP失败的患者提供了IEUC。设置：提供ERCP和介入性EUS的三级护理中心。患者：28例患者是IEUC的候选人。2例患者有出血性肿块，并被称为介入放射学，1例患者有一个大的肿块占据十二指肠腔，和2例患者拒绝IEUC。干预：EUS被用来进入胆道系统后，导丝是先进的顺行通过梗阻。无论是会合与逆行或顺行drainage，然后accomplished.Main结果测量：IEUC的有效性和安全性为biliary decompression.Results：IEUC成功地进行了23例，与transgastric-transshepherd（肝内）的方法在13例和transenteric-transcholedochal（肝外）的方法在10例。21例患者实现了治疗受益：18例成功在狭窄处展开支架，而3例患者需要胆总管肠瘘形成。并发症包括1例胆漏，2例自限性气腹，1例轻微出血。局限性：2名操作者的单中心经验。结论：IEUC似乎在FRCP不成功的患者中有效，并且正在发展成为PTC的有吸引力的替代方案。经肝内途径进入胆道系统似乎比经肝外途径更安全。
Background: Interventional EUS-guided cholangiography (IEUC) has been increasingly used as an alternative to percutaneous transhepatic cholangiography (PTC) in cases of biliary obstruction when ERCP is unsuccessful.Objective: We reviewed our experience and technique used for this procedure.Design: Over a 3-year period, ending July 2005, patients with a failed ERCP were offered an IEUC.Setting: Tertiary care center offering ERCP and interventional EUS.Patients: Twenty-eight patients were candidates for IEUC. Two patients had bleeding masses and were referred to interventional radiology, 1 patient had a large mass occupying the duodenal lumen, and 2 patients refused IEUC.Intervention: EUS was used to access the biliary system after which a guidewire was advanced antegrade across the obstruction. Either rendezvous with retrograde or antegrade drainage was then accomplished.Main Outcome Measurements: Efficacy and safety of IEUC for biliary decompression.Results: IEUC was successfully performed in 23 patients, with a transgastric-transhepatic (intrahepatic) approach in 13 cases and transenteric-transcholedochal (extrahepatic) approach in 10 cases. Therapeutic benefit was achieved in 21 patients: 18 underwent successful stent deployment across the stricture, whereas 3 patients required a choledochoenteric fistula formation. Complications included 1 case of bile leak, 2 cases of self-limited pneumoperitoneum, and 1 case of minor bleeding.Limitations: Single-center experience of 2 operators. Conclusions: IEUC appears efficacious in patients in whom FRCP is unsuccessful and is evolving as an attractive alternative to PTC. Intrahepatic access to the biliary system appears safer than the extrahepatic approach.