EUS-guided hepaticogastrostomy with a fully covered metal stent as the biliary diversion technique for an occluded biliary metal stent after a failed ERCP
EUS-guided hepaticogastrostomy with a fully covered metal stent as the biliary diversion technique for an occluded biliary metal stent after a failed ERCP
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DOI：
10.1016/j.gie.2009.10.015
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发表时间：
2010-02-01
影响因子：
7.7
通讯作者：
Kim, Myung-Hwan
中科院分区：
文献类型：
--
作者：
Park, Do Hyun;Song, Tae-Jun;Kim, Myung-Hwan
背景：ERCP失败后，经皮肝穿胆道引流术(PTBD)可能是闭塞胆道金属支架的最后手段。目的：由于EUS引导下的胆道引流已被认为是ERCP失败后PTBD的有效替代方案，我们开展了这项研究，以确定EUS引导下的肝胃吻合术(EUS-HG)加全覆盖自膨式金属支架(FCSEMS)治疗闭塞胆道金属支架的可行性和有效性。设计：一项病例研究：设置：一个三级参考中心。病例和干预：5名在肝门部金属支架后置入闭塞胆道金属支架的患者。支架或十二指肠和胆道金属支架联合置入，再介入ERCP不成功的患者接受了EUS-HG和FCSEMS替代PTBD。主要结果测量：技术和功能成功，手术并发症、EUS-HG加FCSEMS术后再干预率和支架短期通畅率。结果：在所有5例患者中，EUS-HG加FCSEMS技术上是成功的。无胆汁性腹膜炎、胆管炎、气腹等手术并发症发生。功能成功率为100%(5/5)。术后平均随访152d，~184d，无支架移位、闭塞等晚期并发症发生。限制：无对照组的小范围患者。结论：EUS-HG与FCSEMS联合应用可能是可行、有效的，是ERCP失败后胆道金属支架闭塞的替代PTBD
Background: Percutaneous transhepatic biliary drainage (PTBD) may be the last resort for an occluded biliary metal stent when the ERCP was unsuccessful.Objective: Because an EUS-guided biliary drainage has been proposed as an effective alternative for PTBD after a failed ERCP we conducted this study to determine the feasibility and usefulness of an EUS-guided hepaticogastrostomy (EUS-HG) with a fully covered self-expandable metal stent (FCSEMS) for an Occluded biliary metal stent after a failed ERCPDesign: A case studySetting: A tertiary referral center.Patients and Interventions: Five patients who had an occluded biliary metal stent inserted after a hilar bilateral metal stent or a combined duodenal and biliary metal stent insertion and for whom reinterventional ERCP was unsuccessful underwent an EUS-HG with an FCSEMS for alternative PTBD.Main Outcome Measurements: Technical and functional Success, procedural complications, reinterventional rate after EUS-HG with an FCSEMS, and short-term stent patency.Results: In all 5 patients, an EUS-HG with in FCSEMS was technically successful. No procedural complications, Such as bile peritonitis, cholangitis, and pneumoperitoneum, were observed. Functional success was also 100% (5/5). During the follow-up period (median 152 days, range 64-184 days), no late complications, Such as stent migration and Occlusion, were observed. Thus, no biliary reintervention was performed during the follow-up period.Limitations: A small series of patients Without a Control group.Conclusions: The EUS-HG with in FCSEMS may be feasible, effective, and an alternative PTBD for an Occluded biliary metal stent after a failed ERCP