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) by using 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 in patients with SAA.

Methods

Of 48 patients in whom BE-ERCP failed, percutaneous transhepatic intervention was performed in 11. From November 2013 until November 2017, we retrospectively reviewed cases of an additional 37 patients with SAA who failed BE-ERCP and underwent EUS-AI for benign biliary diseases (common bile duct stones [n = 11], intrahepatic bile duct stones [n = 5], anastomotic strictures [n = 21]).

Results

The overall technical success of the creation of the hepatoenteric 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 was required in 19 cases (guidewire manipulation across the anastomotic stricture [n = 6], cholangioscopy-guided lithotripsy by using electrohydraulic lithotripsy [n = 13]). In 1 case, magnetic compression anastomosis was performed. The final clinical success rate of all EUS-AIs was 91.9%.

Conclusions

EUS-AI for benign biliary diseases in patients with SAA appears to be a feasible and safe alternative procedure after BE-ERCP failure.

中文翻译：

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EUS指导的手术解剖结构改变的患者对良性胆道疾病的顺行干预（视频）

背景和目标

尽管球囊肠镜辅助的ERCP（BE-ERCP）对于解剖结构改变（SAA）的患者的良性胆道疾病有效且安全，但BE-ERCP并非总是成功。最近，针对BE-ERCP失败案例，已经开发出使用1阶段或2阶段程序进行EUS引导的顺行干预（EUS-AI）。本研究的目的是评估EUS-AI对SAA患者的良性胆道疾病的疗效。

方法

在BE-ERCP失败的48例患者中，于11月进行了经皮肝穿刺干预。从2013年11月至2017年11月，我们回顾性分析了另外37例SAA失败的BE-ERCP并接受EUS-AI的良性胆道疾病患者（常见的胆管结石[n = 11]，肝内胆管结石[n = 5]，吻合口狭窄[n = 21]）。

结果

EUS建立肝肠系统的总体技术成功率为91.9％（34/37）。在8.1％的患者中观察到中度不良事件（胆源性腹膜炎[n = 3]）。EUS的一期EUS-AI成功治疗8例（100％），无任何不良事件。在另外26例中，大约1或2个月后进行了ERCP的2期EUS-AI。透视下内镜顺行治疗成功6例。19例需要经口胆管镜辅助顺行干预（通过吻合口狭窄的导丝操作[n = 6]，使用电液碎石术通过胆管镜引导的碎石术[n = 13]）。在1例中，进行了磁压缩吻合术。所有EUS-AI的最终临床成功率为91.9％。

结论

EUS-AI治疗SAA患者的良性胆道疾病似乎是BE-ERCP失败后可行且安全的替代手术。