Background and Aims

EUS-guided hepaticogastrostomy has been performed for many years with most published experience from outside the United States. The luminal access point can be from the esophagus, stomach, duodenum, or jejunum; biliary access can be either into the right or left intrahepatic system. Thus, we prefer the term EUS-guided transhepatic biliary drainage (ETBD). We describe what is believed to be the largest single-center U.S. experience of ETBD for management of benign and malignant biliary disease.

Methods

This was a retrospective study of all ETBD conducted by 1 endoscopist between September 2014 and May 2021.

Results

Two hundred fifteen patients underwent attempted ETBD: 85 for benign disease and 130 for malignant disease. Ninety-two patients (43%) had surgically altered anatomy (SAA). In 94 patients previously endoscopic attempts failed. The approach was transesophageal in 9, transgastric in 188, transduodenal in 5, and transjejunal in 5 patients. In 1 patient a bilateral approach was used. Standard fully covered self-expandable stents of 4- to 10-cm lengths and 8- or 10-mm diameters were used. Technical success was 95.3% and clinical success was 87.25%. Forty patients (18.6%) experienced adverse events (13 mild, 21 moderate, and 6 severe according to the modified American Society for Gastrointestinal Endoscopy lexicon). Mean follow-up was 257.31 ± 308.11 days for all patients (124.53 ± 229.86 days for benign disease and 457.27 ± 466.31 days for malignant disease). Seventy-four patients (34.4%) had died at the time of data collection (66 in the malignant cohort, 8 in the benign cohort). Of those with malignancy surviving >6 months, 17.4% required reintervention.

Conclusions

ETBD is effective in the management of benign and malignant biliary obstruction for patients with SAA as well as native anatomy, with a modest adverse event rate.

中文翻译：

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EUS 引导下经肝胆道引流：一项大型单中心美国经验

背景和目标

EUS 引导下的肝胃造口术已经进行了多年，其中大多数已发表的经验来自美国以外。管腔接入点可以来自食道、胃、十二指肠或空肠；胆道可以进入右侧或左侧肝内系统。因此，我们更喜欢 EUS 引导的经肝胆道引流 (ETBD) 这一术语。我们描述了被认为是最大的单中心 ETBD 治疗良性和恶性胆道疾病的美国经验。

方法

这是一项由 1 名内镜医师在 2014 年 9 月至 2021 年 5 月期间对所有 ETBD 进行的回顾性研究。

结果

215 名患者接受了 ETBD：85 名良性疾病和 130 名恶性疾病。92 名患者 (43%) 进行了手术改变解剖结构 (SAA)。在 94 名患者中，以前的内窥镜尝试失败了。经食道入路 9 例，经胃入路 188 例，经十二指肠入路 5 例，经空肠入路 5 例。1 例患者采用双侧入路。使用长度为 4 至 10 厘米、直径为 8 或 10 毫米的标准全覆盖自膨胀支架。技术成功率为 95.3%，临床成功率为 87.25%。40 名患者 (18.6%) 经历了不良事件（根据修订的美国胃肠内镜学会词典，13 名轻度、21 名中度和 6 名重度）。所有患者的平均随访时间为 257.31 ± 308.11 天（良性疾病为 124.53 ± 229.86 天，457.27 ± 466. 恶性疾病31天）。数据收集时有 74 名患者 (34.4%) 死亡（恶性队列中 66 名，良性队列中 8 名）。在恶性肿瘤存活 > 6 个月的患者中，17.4% 需要再次干预。

结论

ETBD 可有效治疗 SAA 患者的良性和恶性胆道梗阻以及自然解剖结构，不良事件发生率适中。