Prospective international multicenter study on endoscopic ultrasound-guided biliary drainage for patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography

被引：54

作者：

Khashab, Mouen A. ^{[1
]}

Van der Merwe, Schalk ^{[2
]}

Kunda, Rastislav ^{[3
]}

El Zein, Mohamad H. ^{[1
]}

Teoh, Anthony Y. ^{[4
]}

Marson, Fernando P. ^{[5
]}

Fabbri, Carlo ^{[6
]}

Tarantino, Ilaria ^{[7
]}

Varadarajulu, Shyam ^{[8
]}

Modayil, Rani J. ^{[9
]}

Stavropoulos, Stavros N. ^{[9
]}

Penas, Irene ^{[10
]}

Ngamruengphong, Saowanee ^{[1
]}

Kumbhari, Vivek ^{[1
]}

Romagnuolo, Joseph ^{[11
]}

Shah, Raj ^{[12
]}

Kalloo, Anthony N. ^{[1
]}

Perez-Miranda, Manuel ^{[10
]}

Artifon, Everson L. ^{[5
]}

机构：

[1] Johns Hopkins Med Inst, Baltimore, MD 21205 USA

[2] Univ Leuven, Univ Hosp Gastuisberg, Dept Hepatol, Div Liver & Pancreat Biliary Disorders, Leuven, Belgium

[3] Aarhus Univ Hosp, DK-8000 Aarhus, Denmark

[4] Chinese Univ Hong Kong, Prince Wales Hosp, Dept Surg, Hong Kong, Hong Kong, Peoples R China

[5] Univ Sao Paulo, Dept Surg, Sao Paulo, Brazil

[6] AUSL Bologna Bellaria Maggiore Hosp, Unit Gastroenterol & Digest Endoscopy, Bologna, Italy

[7] Mediterranean Inst Transplantat & Adv Specialized, Dept Diagnost & Therapeut Serv, Endoscopy Serv, Palermo, Italy

[8] Florida Hosp, Ctr Intervent Endoscopy, Orlando, FL USA

[9] Winthrop Univ Hosp, Mineola, NY 11501 USA

[10] Hosp Univ Rio Hortega, Valladolid, Spain

[11] Med Univ S Carolina, Div Gastroenterol & Hepatol, Charleston, SC 29425 USA

[12] Univ Colorado, Div Gastroenterol & Hepatol, Anschutz Med Campus, Aurora, CO USA

来源：

ENDOSCOPY INTERNATIONAL OPEN | 2016年 / 4卷 / 04期

关键词：

D O I：

10.1055/s-0042-102648

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background and aims: Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an alternative to traditional radiologic and surgical drainage procedures after failed endoscopic retrograde cholangiopancreatography (ERCP). However, prospective multicenter data are lacking. The aims of this study were to prospectively assess the short- and long-term efficacy and safety of EUS-BD in patients with malignant distal biliary obstruction. Patients and methods: Consecutive patients at 12 tertiary centers (5 US, 5 European, 1 Asian, 1 South American) with malignant distal biliary obstruction and failed ERCP underwent EUS-BD. Technical success was defined as successful stent placement in the desired position. Clinical success was defined as a reduction in bilirubin by 50% at 2 weeks or to below 3mg/dL at 4 weeks. Adverse events were prospectively tracked and graded according to the American Society for Gastrointestinal Endoscopy (ASGE) lexicon's severity grading system. Overall survival and duration of stent patency were calculated using Kaplan-Meier analysis. Results: A total of 96 patients (mean age 66 years, female 45%, pancreatic cancer 55%) underwent EUS-BD. Stent placement (technical success) was achieved in 92 (95.8%) patients (metallic stent 84, plastic stent 8). Mean procedure time was 40 minutes. Clinical success was achieved in 86 (89.5%) patients. A total of 10 (10.5%) adverse events occurred: pneumoperitoneum (n=2), sheared wire (n=1), bleeding (n=1), bile leak (n=3), cholangitis (n=2), and unintentional perforation (n=1); 4 graded as mild, 4 moderate, 1 severe, and 1 fatal (due to perforation). A total of 38 (44%) patients died of disease progression during the study period. The median patient survival was 167 days (95%CI 112-221) days. The 6-month stent patency rate was 95% (95%CI 94.94-95.06%) and the 1-year stent patency was 86% (95%CI 85.74-86.26%). Conclusion: This study on EUS-BD demonstrates excellent efficacy and safety of EUS-BD when performed by experts. Study registration: NCT01889953

引用

页码：E487 / E496

页数：10

共 33 条

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