EUS引导下干预治疗术后解剖结构改变患者的良性胆道疾病（译）

EUS引导下干预治疗术后解剖结构改变患者的良性胆道疾病（译）

背景和目的：虽然气囊小肠镜辅助ERCP（BE-ERCP）对于手术后解剖结构改变的（SAA）患者的良性胆道疾病是有效且安全的，但BE-ERCP并不总能成功实施。 最近，针对BE-ERCP失败病例，进行了EUS引导下的干预治疗（EUS-AI），包括1期或2期。 本研究的目的是评估EUS-AI治疗SAA患者良性胆道疾病的疗效。
方法：本文回顾性分析了2013年11月至2017年11月期间行BE-ERCP失败的48名良性胆道疾病患者，其中11名患者进行了经皮经肝穿刺干预治疗， 另有37例接受了EUS-AI治疗 [胆总管结石（n = 11），肝内胆管结石（n = 5），吻合口狭窄（n = 21）] 。
结果：EUS建立肝肠通道的总体技术成功率为91.9％（34/37）。中度不良事件发生率为8.1％（胆汁性腹膜炎[n = 3]）。 通过EUS的一期EUS-AI在8例（100％）中成功，没有任何不良事件。另有26例通过2期行ERCP，在EUS-AI后大约1或2个月后进行。透视下内镜顺行治疗成功6例。 19例患者需要经口胆道镜辅助干预（穿过狭窄吻合口的导丝操作[n = 6]，在胆管镜引导下进行液电碎石术[n = 13]）。 还有1例行磁性压迫吻合术。 所有EUS-AI的最终临床成功率为91.9％。
结论：在BE-ERCP失败后，EUS-AI用于治疗SAA患者的良性胆道疾病的似乎是一种可行且安全的替代疗法。

EUS-guided antegrade intervention for benign biliary diseases in patients with surgically altered anatomy 
 
Mukai, S., T. Itoi, A. Sofuni, et al.. Gastrointest Endosc  (Aug 1 2018).
 
Abstract
BACKGROUND AND AIMS:Although balloon enteroscopy-assisted ERCP (BE-ERCP) is effective and safe for benign biliary diseases in patients with surgically altered anatomy (SAA), BE-ERCP is not always successful. Recently, EUS-guided antegrade intervention (EUS-AI) including a 1-stage or 2-stage procedure has been developed for BE-ERCP failure cases. The aim of the present study was to evaluate the outcome of EUS-AI for benign biliary diseases with SAA
METHODS:Of 48 patients in whom BE-ERCP failed, percutaneous transhepatic intervention was performed in 11 patients. Another 37 patients who failed BE-ERCP and underwent EUS-AI for benign biliary diseases with SAA [common bile duct stones (n = 11), intrahepatic bile duct stones (n = 5), anastomotic stricture (n = 21)] from November 2013 until November 2017 were retrospectively reviewed.
RESULTS:The overall technical success of the creation of hepaticoenteric tract by EUS was 91.9% (34/37). Moderate adverse events were observed in 8.1% (biliary peritonitis [n=3]). One-stage EUS-AI by EUS succeeded in 8 cases (100%) without any adverse events. In another 26 cases, 2-stage EUS-AI by ERCP was performed about 1 or 2 months later. Endoscopic antegrade therapy under fluoroscopy was successful in 6 cases. Per-oral cholangioscopy-assisted antegrade intervention were required in 19 cases (guidewire manipulation across the anastomotic stricture [n=6], cholangioscopy-guided lithotripsy using electrohydraulic lithotripsy [n=13]). In 1 case, magnetic compression anastomosis was performed. The final clinical success rate of all EUS-AI was 91.9%.
CONCLUSIONS:EUS-AI for benign biliary diseases with SAA appears to be a feasible and safe alternative procedure after BE-ERCP failure.

翻译：于廷廷   审校：张立超、侯森林