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ID 58582
Author
Tomoda, Takeshi Department of Gastroenterology and Hepatology, Okayama University Hospital
Kato, Hironari Department of Gastroenterology and Hepatology, Okayama University Hospital Kaken ID researchmap
Miyamoto, Kazuya Department of Gastroenterology and Hepatology, Okayama University Hospital
Matsumi, Akihiro Department of Gastroenterology and Hepatology, Okayama University Hospital
Ueta, Eijiro Department of Gastroenterology and Hepatology, Okayama University Hospital
Fujii, Yuuki Department of Gastroenterology and Hepatology, Okayama University Hospital
Saragai, Yousuke Department of Gastroenterology and Hepatology, Okayama University Hospital
Yamazaki, Tatsuhiro Department of Gastroenterology and Hepatology, Okayama University Hospital
chida, Daisuke Department of Gastroenterology and Hepatology, Okayama University Hospital
atsumoto, Kazuyuki Department of Gastroenterology and Hepatology, Okayama University Hospital
Horiguchi, Shigeru Department of Gastroenterology and Hepatology, Okayama University Hospital
Tsutsumi, Koichiro Department of Gastroenterology and Hepatology, Okayama University Hospital
Okada, Hiroyuki Department of Gastroenterology and Hepatology, Okayama University Hospital Kaken ID researchmap
Abstract
Background
To evaluate the outcomes of endoscopic retrograde cholangiopancreatography (ERCP) for malignant biliary obstruction (MBO) using short-type double-balloon enteroscope (sDBE) in patients with surgically altered anatomy.
Methods
A total of 45 patients with surgically altered anatomy underwent ERCP using sDBE for the treatment of MBO between April 2011 and March 2019. We retrospectively evaluated the clinical and technical success (insertion and biliary intervention success), adverse events, and risk factors for clinical failure.
Results
The scope was successfully inserted in the target site in 82.2% of patients (37/45), and among them, biliary intervention success was achieved in 86.4% (32/37). The overall technical success rate was 71.1% (32/45) and clinical success rate was 68.9% (31/45), with an adverse event rate of 11.1%. In multivariate analysis, the presence of peritoneal dissemination (odds ratio, 7.3; 95% confidence interval, 1.5–43.5, p = 0.02) was as an independent risk factor for clinical failure. The clinical success rate was 38.5% in patients with peritoneal dissemination and 81.3% in those without peritoneal dissemination.
Conclusion
Endoscopic treatment using sDBE in patients without peritoneal dissemination provided favorable outcomes, and it can be an initial treatment for MBO in patients with surgically altered anatomy.
Endoscopic biliary stent placement with endoscopic retrograde cholangiography (ERCP) for the treatment of malignant biliary obstruction (MBO) has been widely accepted as an effective drainage method because it is less invasive and safe and has a high success rate (1–3). However, MBO is treated using percutaneous transhepatic biliary drainage (PTBD) or surgical bypass because of difficulties related to endoscopic access to the bile duct following gastrointestinal reconstruction. However, these methods are associated with marked adverse event (AE) rates [1,2,3].
Recently, balloon-assisted endoscopy (BAE) facilitates ERCP in patients with surgically altered anatomy. As for a double-balloon enteroscope (DBE), a short-type DBE (sDBE) is especially useful because it allows the use of many standard ERCP accessories.
The success rates of reaching the target site and ERCP-related interventions associated using these endoscopes range from 73–100% and 85–100%, respectively [4, 5]. We previously reported that the success rate of reaching the target site and biliary intervention was 93.8% and 95.7%, respectively, in patients with benign hepaticojejunostomy (HJ) anastomotic stricture [6].
However, inaccessibility of the target site may occur due to severe postoperative adhesions or a long insertion time (i.e., > 60 min). Furthermore, previous reports have shown that the success rate of BAE in MBO cases was significantly lower than that in benign biliary diseases [7, 8]. Few reports have investigated the outcome of BAE for MBO in patients with surgically altered anatomy. Additionally, the risk factors for clinical failure are not well-established.
Thus, we retrospectively evaluated the outcomes of endoscopic treatment for MBO using sDBE in patients with surgically altered anatomy and identified risk factors for clinical failure.
Keywords
Malignant biliary obstruction
Double-balloon enteroscope
Endoscopic retrograde cholangiopancreatography
Surgically altered anatomy
Note
This fulltext is aailable in Jan. 2021.
Published Date
2020-01-16
Publication Title
Surgical Endoscopy
ISSN
09302794
NCID
AA10750363
Content Type
Journal Article
language
英語
OAI-PMH Set
岡山大学
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author
PubMed ID
DOI
Web of Science KeyUT
Related Url
isVersionOf https://doi.org/10.1007/s00464-020-07385-y