EUS-guided gallbladder drainage for rescue treatment of malignant distal biliary obstruction after unsuccessful ERCP

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• 作者：Hajime Imai ; MD ; Masayuki Kitano ; MD ; PhD ; Shunsuke Omoto ; MD ; Kumpei Kadosaka ; MD ; Ken Kamata ; MD ; PhD ; Takeshi Miyata ; MD ; Kentaro Yamao ; MD ; Hiroki Sakamoto ; MD ; PhD ; Yogesh Harwani ; MD ; Masatoshi Kudo ; MD ; PhD
• 关键词：EUS-BD ; EUS-guided bile duct drainage ; EUS-CDS ; EUS-guided choledochoduodenostomy ; EUS-GBD ; EUS-guided gallbladder drainage ; EUS-HGS ; EUS-guided hepaticogastrostomy ; EUS-RVS ; EUS-guided rendezvous stenting ; PTBD ; percutaneous transhepatic biliary drainage ; SEMS ; self-expandable metal stent
• 刊名：Gastrointestinal Endoscopy
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：84
• 期：1
• 页码：147-151
• 全文大小：642 K

文摘

EUS-guided bile duct drainage (EUS-BD) is a well-recognized rescue biliary drainage method after unsuccessful ERCP. EUS-guided gallbladder drainage (EUS-GBD) was recently used to treat acute cholecystitis. The aim of this study was to assess the efficacy and safety of EUS-GBD for malignant biliary stricture–induced obstructive jaundice after unsuccessful ERCP as well as unsuccessful or impractical EUS-BD.

Methods

Between January 2006 and October 2014, 12 patients with obstructive jaundice due to unresectable malignant distal biliary stricture underwent EUS-GBD after ERCP failed. EUS-GBD was performed under the guidance of EUS and fluoroscopy by puncturing the gallbladder with a needle, inserting a guidewire, dilating the puncture hole, and placing a stent. The technical and functional success rates, adverse events rate, overall patient survival time, and stent dysfunction rate during patient survival were measured.

Results

The rates of technical success, functional success, adverse events, and stent dysfunction were 100%, 91.7%, 16.7%, and 8.3%, respectively. The median survival time after EUS-GBD was 105 days (range 15 - 236 days).

Conclusions

EUS-GBD is a possible alternative route for decompression of the biliary system when ERCP is unsuccessful.