Value of endoscopic ultrasonography-guided biliary drainage for malignant obstructive jaundice( with video)
10.3760/cma.j.issn.1007-5232.2018.08.006
- VernacularTitle:内镜超声引导下胆管引流术治疗恶性梗阻性黄疸的价值(含视频)
- Author:
Cui CHEN
1
;
Zhixia YE
;
Bo SUN
;
Tiantian WANG
;
Shuping WANG
;
Shuzhi WANG
;
Bing HU
Author Information
1. 东方肝胆外科医院内镜科
- Keywords:
Endosonography;
Biliary drainage;
Hepaticogastrostomy;
Choledochoduodenostomy;
Complication
- From:
Chinese Journal of Digestive Endoscopy
2018;35(8):557-561
- CountryChina
- Language:Chinese
-
Abstract:
Objective To analyze the efficacy of endoscopic ultrasonography-guided biliary drainage ( EUS-BD) for malignant obstructive jaundice and the management of adverse events. Methods Clinical data of 12 patients with malignant obstructive jaundice, who underwent EUS-BD between April 2016 and January 2017, were retrospectively analyzed. All patients received EUS-BD after unsuccessful ERCP, including EUS-guided hepaticogastrostomy ( EUS-HGS ) , EUS-guided antegrade stenting ( EUS-AS ) , and EUS-guided choledochoduodenostomy(EUS-CDS). Procedure outcomes, serum bilirubin and liver enzyme levels before the procedure and 1 week after, complications, treatment results, hospitalization time and follow-up were recorded. Results Two patients underwent EUS-HGS, 3 underwent EUS-AS, and 7 underwent EUS-CDS. Total bilirubin ( t=3. 462, P=0. 005 ) , direct bilirubin ( t=3. 351, P=0. 006 ) , alanine transaminase (t=2. 399, P=0. 037), γ-glutamate transpeptidase (t=3. 256, P=0. 031) reduced significantly after the procedure. Two patients ( 16. 67％) developed complications. A patient undergoing EUS-HGS developed bile leakage, biliary peritonitis, and pneumoperitoneum. A patient undergoing EUS-CDS developed upper gastrointestinal bleeding. Both patients were successfully treated. There were no other adverse events, such as acute pancreatitis, subcutaneous emphysema, pneumothorax and emphysema. No procedure-related death occurred. The mean hospital stay was 13. 75 ± 6. 92 days ( range 5-26 days ) . Conclusion EUS-BD is a safe substitute after unsuccessful ERCP when performed by experienced biliary endoscopists. However, intensive care is necessary after the procedure for early detection and management of complications.
