Endoscopic and percutaneous biliary interventions in patients with altered upper gastrointestinal anatomy-the Munich Multicenter Experience
Endoscopic and percutaneous biliary interventions in patients with altered upper gastrointestinal anatomy-the Munich Multicenter Experience
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DOI：
10.1007/s00464-020-08191-2
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发表时间：
2021-01-04
影响因子：
3.1
通讯作者：
Neu, Bruno
中科院分区：
文献类型：
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作者：
Nennstiel, Simon;Freivogel, Kathrin;Neu, Bruno
背景在上消化道解剖结构改变的患者中，常规的内窥镜逆行胆道造影术往往是不可能的，需要不同的技术，如肠镜辅助或经皮途径。这项研究的目的是分析在超声前胆道引流时代，在日常临床实践中，这些技术的成功率和并发症发生率。患者和方法回顾分析2006年3月1日至2014年6月30日在德国慕尼黑4个三级内窥镜中心行胆道介入治疗的上消化道解剖改变的患者。结果411例患者中，234例(56.9%)至少一次成功，其中第一次成功192例，第二次成功34例，第三次成功8例。Billroth-II/Whiple-/Roux-en-Y重建成功率分别为70.5%、56.7%、49.5%。并发症发生率分别为9.3%/6.5%/6.3%，总的并发症发生率为7.1%。在可以使用十二指肠镜的情况下，Billroth-II重建的患者成功率最高，在这种情况下并发症发生率也最高。在Roux-en-Y重建等较长肢体解剖方面的成功率最低。经皮胆道引流(PTBD)268次，成功率(90.7%)和并发症发生率(11.6%)显著高于内窥镜方法。与内窥镜治疗的患者相比，PTBD患者的表现状态较差，胆汁淤积更严重，恶性基础疾病的发生率显著高于内窥镜治疗的患者。结论在上消化道解剖结构改变的患者中，内窥镜辅助胆道介入治疗的成功率低于PTBD。尽管如此，由于内窥镜方法的有益并发症发生率，只要有可能，这项技术应该是首选的，对于仍需详细定义的选定患者，重复的内窥镜尝试有助于达到预期的结果。
Background In patients with altered upper gastrointestinal anatomy, conventional endoscopic retrograde cholangiography is often not possible and different techniques, like enteroscopy-assisted or percutaneous approaches are required. Aim of this study was to analyze success and complication rates of these techniques in a large collective of patients in the daily clinical practice in a pre-endosonographic biliary drainage era. Patients and methods Patients with altered upper gastrointestinal anatomy with biliary interventions between March 1st, 2006, and June 30th, 2014 in four tertiary endoscopic centers in Munich, Germany were retrospectively analyzed. Results At least one endoscopic-assisted biliary intervention was successful in 234/411 patients (56.9%)-in 192 patients in the first, in 34 patients in the second and in 8 patients in the third attempt. Success rates for Billroth-II/Whipple-/Roux-en-Y reconstruction were 70.5%/56.7%/49.5%. Complication rates for these reconstructions were 9.3%/6.5%/6.3%, the overall complication rate was 7.1%. Success rates were highest in patients with Billroth-II reconstruction where use of a duodenoscope was possible, complication rates were also highest in this scenario. Success rates were lowest in longer-limb anatomy like Roux-en-Y reconstruction. Percutaneous biliary drainages (PTBD) were inserted 268 times with substantially higher success (90.7%) as well as complication rates (11.6%) compared to the endoscopic approach. Compared to patients treated endoscopically, patients with PTBD had a lower performance status, more severe cholestasis and a significant higher rate of malignant underlying disease. Conclusion In patients with altered upper gastrointestinal anatomy, success rates of endoscopic-assisted biliary interventions are lower compared to PTBD. Still, due to the beneficial complication rates of the endoscopic approach, this technique should be preferred whenever possible and in selected patients who still need to be defined in detail, repeated endoscopic attempts are useful to help achieve the desired result.