Transmural Biliary Drainage Can Be an Alternative to Transpapillary Drainage in Patients with an Indwelling Duodenal Stent

被引：66

作者：

Hamada, Tsuyoshi ^{[1
]}

Isayama, Hiroyuki ^{[1
]}

Nakai, Yousuke ^{[1
]}

Kogure, Hirofumi ^{[1
]}

Yamamoto, Natsuyo ^{[1
]}

Kawakubo, Kazumichi ^{[1
]}

Takahara, Naminatsu ^{[1
]}

Uchino, Rie ^{[1
]}

Mizuno, Suguru ^{[1
]}

Sasaki, Takashi ^{[1
]}

Togawa, Osamu ^{[1
]}

Matsubara, Saburo ^{[2
]}

Ito, Yukiko ^{[3
]}

Hirano, Kenji ^{[1
]}

Tsujino, Takeshi ^{[3
]}

Tada, Minoru ^{[1
]}

Koike, Kazuhiko ^{[1
]}

机构：

[1] Univ Tokyo, Grad Sch Med, Dept Gastroenterol, Bunkyo Ku, Tokyo 1138655, Japan

[2] Tokyo Metropolitan Police Hosp, Dept Gastroenterol, Nakano Ku, Tokyo 1648541, Japan

[3] Japanese Red Cross Med Ctr, Dept Gastroenterol, Shibuya Ku, Tokyo 1508935, Japan

来源：

DIGESTIVE DISEASES AND SCIENCES | 2014年 / 59卷 / 08期

基金：

日本学术振兴会;

关键词：

Distal malignant biliary obstruction; Endoscopic retrograde cholangiopancreatography; Endoscopic ultrasound; Gastric outlet obstruction; Stent; GASTRIC OUTLET OBSTRUCTION; UNRESECTABLE PANCREATIC-CANCER; EXPANDABLE METAL STENTS; MALIGNANT BILIARY; GUIDED HEPATICOGASTROSTOMY; JAPANESE MULTICENTER; COVERED WALLSTENT; RANDOMIZED-TRIAL; PLACEMENT; PALLIATION;

D O I：

10.1007/s10620-014-3062-1

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Self-expandable metal stents (SEMS) are widely utilized to relieve symptoms of malignant gastric outlet obstruction (GOO), but GOO is frequently complicated by nonresectable distal biliary obstruction. The optimal endoscopic approach to biliary drainage in this setting remains controversial and has yet to be resolved. To compare the safety and efficacy of endoscopic ultrasound-guided transmural biliary drainage (EUS-BD) and transpapillary drainage in patients with an indwelling duodenal SEMS. Patients who underwent EUS-BD or transpapillary drainage for distal malignant biliary obstruction with an indwelling duodenal SEMS between June 2007 and August 2012 at three Japanese tertiary referral centers were identified retrospectively. We compared times to stent dysfunction, causes of dysfunction, and procedural related complications between these two groups. Twenty patients were included in the study (7 EUS-BD and 13 transpapillary drainage). EUS-BD was performed via hepaticogastrostomy using a SEMS in three patients and via choledochoduodenostomy using a SEMS or a plastic stent in two patients each. Transpapillary drainage was performed using a SEMS in all patients. The stent patency rate in the EUS-BD group was higher than that in the transpapillary drainage group (100 vs. 71 % at 1 month and 83 vs. 29 % at 3 months, respectively). The rate of stent dysfunction in the EUS-BD group tended to be lower than that in the transpapillary group (14 vs. 54 %; P = 0.157). Complication rates were similar between the groups (P = 1.000), with moderate bleeding in one patient in the EUS-BD group and mild pancreatitis in one patient in the transpapillary group. Endoscopic ultrasound-guided transmural biliary drainage is an alternative to transpapillary drainage in patients with an indwelling duodenal SEMS.

引用

页码：1931 / 1938

页数：8

共 36 条

[1] Current concepts: Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract. [J].