内镜超声引导下对有全胃切除术史的患者进行肝空肠吻合术：一项多中心回顾性可行性研究。

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy Pub Date : 2025-01-01 DOI:10.1016/j.gie.2024.07.011

Daniele Balducci MD , Jean-Philippe Ratone MD , Marion Schaefer MD , Sébastien Godat MD , Enrique Perez-Cuadrado-Robles MD , Solene Hoibian MD , Yanis Dahel MD , Meddy Dalex MD , Jean-Baptiste Chevaux MD , Fabrice Caillol MD , Marc Giovannini MD

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引用次数: 0

摘要

背景和目的：内镜超声引导肝胃造口术（EUS-HGS）是一种有效的胆道引流技术，适用于解剖结构改变或十二指肠狭窄的患者。内镜超声引导下肝空肠吻合术（EUS-HJS）可用于在有全胃切除术史的患者的左肝管和空肠之间建立瘘管。关于这项技术的具体数据尚未公布。本研究旨在评估 EUS-HJS 在全胃切除术患者中的可行性和安全性：这项回顾性多中心研究纳入了 2011 年 5 月至 2023 年 2 月期间在三家法国三级医疗中心和一家瑞士三级医疗中心接受 EUS-HJS 治疗的所有成年患者。主要结果是临床成功，即瘙痒、黄疸和/或胆管炎消失。胆红素在术后一周内改善超过 30% 和/或术后一个月内胆红素恢复正常也被视为临床成功的指标。次要结果包括技术成功率、不良事件发生率、内镜翻修需求、恢复抗癌治疗的可能性、中位生存率以及与 EUS-HGS 相比的技术差异：共纳入了 21 例通过 EUS-HJS 进行全胃切除术的患者。100%的患者获得了技术成功（95% CI 85%-100%）。80%的患者取得了临床成功（95% CI 58%-92%）。记录的不良事件发生率为 33% (95% CI 17%-55%)，胆管炎是最常见的并发症。七名患者（39%）在术后接受了抗癌治疗。中位生存期为6个月（IQR 1.5-12）：结论：对于因全胃切除术而导致解剖结构改变的患者来说，EUS-HJS 是一种有效且可行的手术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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EUS-guided hepaticojejunostomy in patients with history of total gastrectomy: a multicenter retrospective feasibility study (with video)

Background and Aims

EUS-guided hepaticogastrostomy (EUS-HGS) is an effective biliary drainage technique for patients with altered anatomy or duodenal strictures. EUS-guided hepaticojejunostomy (EUS-HJS) can be used to create a fistula between the left hepatic duct and the jejunum in patients with a history of total gastrectomy. No specific data on this technique have been published. The aim of this study was to assess the feasibility and safety of EUS-HJS in patients with a history of total gastrectomy.

Methods

This retrospective multicenter study included all adult patients who underwent EUS-HJS at 3 tertiary French centers and 1 tertiary Swiss center between May 2011 and February 2023. The primary outcome was clinical success, which was defined as the disappearance of pruritus, jaundice, and/or cholangitis. An improvement in bilirubin >30% within the first week and/or bilirubin normalization within 1 month after the procedure were also considered indicators of clinical success. Secondary outcomes were technical success, rate of adverse events, need for endoscopic revision, possibility of resuming anticancer treatment, median survival, and technical differences compared with EUS-HGS.

Results

Twenty-one patients with history of complete gastrectomy who underwent EUS-HJS were included. Technical success was achieved in 100% of patients (95% confidence interval [CI], 85-100). Clinical success was achieved in 80% of patients (95% CI, 58-92). The incidence of recorded adverse events was 33% (95% CI, 17-55), with cholangitis being the most frequent adverse event. Seven patients (39%) were able to benefit from anticancer treatment after the procedure. Median survival time was 6 months (interquartile range, 1.5-12).

Conclusions

EUS-HJS is an effective and feasible procedure for patients whose anatomy has been altered by total gastrectomy.

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来源期刊

Gastrointestinal endoscopy 医学-胃肠肝病学

CiteScore

10.30

自引率

7.80%

发文量

1441

审稿时长

38 days

期刊介绍： Gastrointestinal Endoscopy is a journal publishing original, peer-reviewed articles on endoscopic procedures for studying, diagnosing, and treating digestive diseases. It covers outcomes research, prospective studies, and controlled trials of new endoscopic instruments and treatment methods. The online features include full-text articles, video and audio clips, and MEDLINE links. The journal serves as an international forum for the latest developments in the specialty, offering challenging reports from authorities worldwide. It also publishes abstracts of significant articles from other clinical publications, accompanied by expert commentaries.