摘要
AIM:To determine the utility of endoscopic ultrasoundguided biliary drainage(EUS-BD)with a fully covered self-expandable metal stent for managing malignant biliary stricture. METHODS:We collected data from 13 patients who presented with malignant biliary obstruction and underwent EUS-BD with a nitinol fully covered selfexpandable metal stent when endoscopic retrograde cholangiopancreatography(ERCP)fails.EUS-guided choledochoduodenostomy(EUS-CD)and EUS-guided hepaticogastrostomy(EUS-HG)was performed in 9 patients and 4 patients,respectively. RESULTS:The technical and functional success rate was 92.3%(12/13)and 91.7%(11/12),respectively. Using an intrahepatic approach(EUS-HG,n=4),there was mild peritonitis(n=1)and migration of the metal stent to the stomach(n=1).With an extrahepatic approach(EUS-CD,n=10),there was pneumoperitoneum(n=2),migration(n=2),and mild peritonitis (n=1).All patients were managed conservatively with antibiotics.During follow-up(range,1-12 mo),there was re-intervention(4/13 cases,30.7%)necessitated by stent migration(n=2)and stent occlusion(n=2). CONCLUSION:EUS-BD with a nitinol fully covered self-expandable metal stent may be a feasible and effective treatment option in patients with malignant biliary obstruction when ERCP fails.
AIM：To determine the utility of endoscopic ultrasoundguided biliary drainage（EUS-BD）with a fully covered self-expandable metal stent for managing malignant biliary stricture. METHODS：We collected data from 13 patients who presented with malignant biliary obstruction and underwent EUS-BD with a nitinol fully covered selfexpandable metal stent when endoscopic retrograde cholangiopancreatography（ERCP）fails.EUS-guided choledochoduodenostomy（EUS-CD）and EUS-guided hepaticogastrostomy（EUS-HG）was performed in 9 patients and 4 patients,respectively. RESULTS：The technical and functional success rate was 92.3%（12/13）and 91.7%（11/12）,respectively. Using an intrahepatic approach（EUS-HG,n=4）,there was mild peritonitis（n=1）and migration of the metal stent to the stomach（n=1）.With an extrahepatic approach（EUS-CD,n=10）,there was pneumoperitoneum（n=2）,migration（n=2）,and mild peritonitis （n=1）.All patients were managed conservatively with antibiotics.During follow-up（range,1-12 mo）,there was re-intervention（4/13 cases,30.7%）necessitated by stent migration（n=2）and stent occlusion（n=2）. CONCLUSION：EUS-BD with a nitinol fully covered self-expandable metal stent may be a feasible and effective treatment option in patients with malignant biliary obstruction when ERCP fails.
基金
Supported by Institute of Wonkwang Medical Science in 2011
作者简介
Correspondence to： Tae Hyeon Kim, MD, Associate Pro- fessor, Department of Internal Medicine, School of Medicine, Wonkwang University, Iksan, Chonbuk 570-749, South Korea. kth@wonkwang.ac.kr Telephone： ＋82-63-8592564 Fax： ＋82-63-8502205
