摘要
AIM:To investigate the long-term outcomes of endoscopic ultrasound-guided choledochoduodenostomy(EUS-CDS) with a fully covered self-expandable metallic stent(FCSEMS).METHODS:From April 2009 to August 2010,15 patients with distal malignant biliary obstructions who were candidates for alternative techniques for biliary decompression due to a failed endoscopic retrograde cholangiopancreatography(ERCP) were included.These 15 patients consisted of 8 men and 7 women and had a median age of 61 years(range:30-91 years).The underlying causes of the distal malignant biliary obstruction were pancreatic cancer(n = 9),ampulla of Vater cancer(n = 2),renal cell carcinoma(n = 1),advanced gastric cancer(n = 1),lymphoma(n = 1),and duodenal cancer(n = 1).RESULTS:The technical success rate of EUS-CDS with an FCSEMS was 86.7%(13/15),and functional success was achieved in 100%(13/13) of those cases.In two patients,the EUS-CDS failed because an FCSEMS with a delivery device could not be passed into the common bile duct.The mean duration of stent patency was 264 d.Early adverse events developed in three patients(3/13,23.1%),including self-limited pneumoperitoneum in two patients and cholangitis requiring stent reposition in one patient.During the follow-up period(median:186 d,range:52-388 d),distal stent migration occurred in four patients(4/13,30.8%).In 3 patients,the FCSEMS could be reinserted through the existing choledochoduodenal fistula tract.CONCLUSION:EUS-CDS with an FCSEMS is technically feasible and can lead to effective palliation of distal malignant biliary obstructions after failed ERCP.
AIM：To investigate the long-term outcomes of endoscopic ultrasound-guided choledochoduodenostomy（EUS-CDS） with a fully covered self-expandable metallic stent（FCSEMS）.METHODS：From April 2009 to August 2010,15 patients with distal malignant biliary obstructions who were candidates for alternative techniques for biliary decompression due to a failed endoscopic retrograde cholangiopancreatography（ERCP） were included.These 15 patients consisted of 8 men and 7 women and had a median age of 61 years（range：30-91 years）.The underlying causes of the distal malignant biliary obstruction were pancreatic cancer（n = 9）,ampulla of Vater cancer（n = 2）,renal cell carcinoma（n = 1）,advanced gastric cancer（n = 1）,lymphoma（n = 1）,and duodenal cancer（n = 1）.RESULTS：The technical success rate of EUS-CDS with an FCSEMS was 86.7%（13/15）,and functional success was achieved in 100%（13/13） of those cases.In two patients,the EUS-CDS failed because an FCSEMS with a delivery device could not be passed into the common bile duct.The mean duration of stent patency was 264 d.Early adverse events developed in three patients（3/13,23.1%）,including self-limited pneumoperitoneum in two patients and cholangitis requiring stent reposition in one patient.During the follow-up period（median：186 d,range：52-388 d）,distal stent migration occurred in four patients（4/13,30.8%）.In 3 patients,the FCSEMS could be reinserted through the existing choledochoduodenal fistula tract.CONCLUSION：EUS-CDS with an FCSEMS is technically feasible and can lead to effective palliation of distal malignant biliary obstructions after failed ERCP.
基金
Supported by The 2012 Inje University Research Grant
