Comparison of endosonography-guided vs. percutaneous biliary stenting when papilla is inaccessible for ERCP
Comparison of endosonography-guided vs. percutaneous biliary stenting when papilla is inaccessible for ERCP
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DOI：
10.1177/2050640613490928
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发表时间：
2013-08-01
影响因子：
6
通讯作者：
Aher, Advay
中科院分区：
文献类型：
--
作者：
Bapaye, Amol;Dubale, Nachiket;Aher, Advay
背景：内窥镜逆行胆管造影（ERCP）和胆道支架植入术在5-10%的恶性胆道梗阻患者中失败，因为乳头无法到达。经皮经肝胆道引流（PTBD）是一种可接受的替代方法。超声引导下的胆道引流术（EUS-BD）最近得到了介绍。目的：比较EUS-BD与PTBD内支架植入术的成功率及并发症。方法：本回顾性研究包括因乳头不可触及行PTBD或EUS-BD而无法手术的恶性胆道梗阻的ERCP失败。排除经皮经肝胆道造影引导/ eus引导的交会手术。PTBD内支架置入失败后，行外引流。EUS-BD采用肝内或肝外入路，通过经壁（胆总管-十二指肠造口术或肝胃造口术）或顺行入路放置支架。两组均放置自膨胀金属支架或塑料支架。采用t检验和卡方检验比较内支架置入成功率和并发症。结果：回顾性分析了6年（2005-2011）的记录，发现50例患者符合要求标准。在25例患者中尝试EUS-BD，在26例患者中尝试PTBD（从EUS-BD到PTBD的一次交叉）。在23/25例EUS-BD患者（92%）和12/26例PTBD患者（46%）中，内支架置入术在技术和临床上都是成功的（p< 0.05）。其余14例PTBD患者行外置导管引流。并发症发生在5/25 (20%)EUS-BD（1例严重，4例轻微）和12/26 (46%)PTBD（4例严重，8例轻微，p< 0.05）。1例EUS-BD和3例PTBD发生晚期支架闭塞。结论：在这项回顾性研究中，我们比较了EUS-BD和PTBD在无法手术的恶性胆道梗阻和无法触及的乳头患者中的成功率和并发症，发现EUS-BD在两种比较者中都优于PTBD。
Background: Endoscopic retrograde cholangiopancreatography (ERCP) and biliary stenting fails in 5-10% patients of malignant biliary obstruction because papilla is inaccessible. Percutaneous transhepatic biliary drainage (PTBD) is an accepted alternative. Endosonography-guided biliary drainage (EUS-BD) has been described recently.Aim: To compare success rates and complications of EUS-BD and PTBD internal stenting.Methods: This retrospective study included failed ERCP in inoperable malignant biliary obstruction due to inaccessible papilla undergoing PTBD or EUS-BD. Percutaneous transhepatic cholangiography guided/EUS-guided rendezvous procedures were excluded. When PTBD internal stenting failed, external drainage was performed. EUS-BD was performed using either intra-or extrahepatic approach, and stents were placed by transmural (choledocho-duodenostomy or hepatico-gastrostomy) or antegrade approach. Self-expandable metallic stents or plastic stents were placed in both groups. Success of internal stenting and complications were compared using t-test and chi-squared test.Results: Retrospective review of 6 years of records (2005-2011) revealed 50 patients meeting the required criteria. EUS-BD was attempted in 25 and PTBD in 26 patients (one crossover from EUS-BD to PTBD). Internal stenting was technically and clinically successful in 23/25 (92%) EUS-BD vs. 12/26 (46%) PTBD (p< 0.05). External catheter drainage was performed in remaining 14 PTBD patients. Complications occurred in 5/25 (20%) EUS-BD (one major, four minor) and in 12/26 (46%) PTBD (four major, eight minor; p< 0.05). Late stent occlusion occurred in one EUS-BD and three PTBD.Conclusions: In this retrospective study comparing success and complications of EUS-BD and PTBD in patients with inoperable malignant biliary obstruction and inaccessible papilla, EUS-BD was found superior to PTBD for both comparators.