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EUS-directed transenteric ERCP in non-Roux-en-Y gastric bypass surgical anatomy patients (with video).
Gastrointestinal Endoscopy ( IF 6.7 ) Pub Date : 2020-01-07 , DOI: 10.1016/j.gie.2019.12.043
Yervant Ichkhanian 1 , Juliana Yang 1 , Theodore W James 2 , Todd H Baron 2 , Shayan Irani 3 , John Nasr 4 , Reem Z Sharaiha 5 , Ryan Law 6 , Andreas Wannhoff 7 , Mouen A Khashab 1
Affiliation  

BACKGROUND AND AIMS Enteroscopy-assisted ERCP is challenging in patients with surgically altered upper GI anatomy. This study evaluated a novel procedure, EUS-directed transenteric ERCP (EDEE), in the de novo creation of an enteroenteric anastomosis for the performance of ERCP in non-Roux-en Y gastric bypass (RYGB) patients. METHODS This was a multicenter retrospective study involving 7 centers between January 2014 and October 2018. Primary outcome was clinical success (completion of EDEE and ERCP with intended interventions), and secondary outcomes were technical success and rate/severity of adverse events. RESULTS Eighteen patients (mean age, 63 years; 13 women) were included. The most common type of surgical anatomy was Whipple (10/18) and Roux-en-Y hepaticojejunostomy (6/18). Technical success rate of EUS-guided lumen-apposing metal stent (LAMS) placement was 100% and of ERCP was 94.44% (17/18). Fourteen patients underwent separate-session EDEE with a median of 21 days (interquartile range [IQR], 11.5-36) between the 2 procedures. Median total procedure time was 111 minutes (IQR, 81-192). Clinical success and adverse events occurred in 17 (94.4%) and 1 (5.6%; abdominal pain) patients, respectively, during a median follow-up of 88 days (IQR, 54-142). CONCLUSIONS This study suggests that EDEE using LAMSs is feasible and safe in patients with non-RYGB surgical anatomy and complex pancreaticobiliary pathologies.

中文翻译:

非Roux-en-Y胃旁路手术的解剖患者以EUS指导的跨肠ERCP(视频)。

背景和目的肠镜辅助的ERCP对于外科手术改变了上消化道解剖结构的患者具有挑战性。这项研究评估了一种新方法,即EUS指导的跨肠ERCP(EDEE),从头开始创建肠肠吻合术,以在非Roux-en Y胃旁路(RYGB)患者中进行ERCP。方法这是一项多中心回顾性研究,涉及2014年1月至2018年10月之间的7个中心。主要结局是临床成功(EDEE和ERCP的完成以及预期的干预措施),次要结局是技术成功和不良事件的发生率/严重程度。结果纳入18例患者(平均年龄63岁; 13例女性)。最常见的手术解剖学类型是Wh​​ipple(10/18)和Roux-en-Y肝空肠吻合术(6/18)。EUS引导管腔内金属支架(LAMS)放置的技术成功率为100%,ERCP为94.44%(17/18)。两次手术之间有14例患者接受了独立治疗EDEE,平均时间为21天(四分位间距[IQR],11.5-36)。中位总手术时间为111分钟(IQR,81-192)。在中位随访88天中,分别有17例(94.4%)和1例(5.6%;腹痛)患者发生了临床成功和不良事件(IQR,54-142)。结论这项研究表明,使用LAMS的EDEE在非RYGB手术解剖学和复杂胰胆管病变的患者中既可行又安全。中位总手术时间为111分钟(IQR,81-192)。在中位随访88天中,分别有17例(94.4%)和1例(5.6%;腹痛)患者发生了临床成功和不良事件(IQR,54-142)。结论这项研究表明,使用LAMS的EDEE在非RYGB手术解剖学和复杂胰胆管病变的患者中既可行又安全。中位总手术时间为111分钟(IQR,81-192)。在中位随访88天中,分别有17例(94.4%)和1例(5.6%;腹痛)患者发生了临床成功和不良事件(IQR,54-142)。结论这项研究表明,使用LAMS的EDEE在非RYGB手术解剖学和复杂胰胆管病变的患者中既可行又安全。
更新日期:2020-01-07
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