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
关键词
金属支架
内镜
引导
超声
覆膜
胰腺癌
完全覆盖
肠吻合术
Bile duct obstruction Drainage Endosonography Self-expandable metallic stent Neoplasms
