Clinical utility of the forward-viewing echoendoscope in patients after pancreatoduodenectomy: A prospective study

IF 4.4 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Endoscopic Ultrasound Pub Date : 2023-11-03 DOI:10.1097/eus.0000000000000027
Hirotoshi Ishiwatari, Junichi Kaneko, Junya Sato, Tatsunori Satoh, Kazuma Ishikawa, Fumitaka Niiya, Hiroyuki Matsubayashi, Tatsunori Minamide, Yuki Maeda, Youichi Yamamoto, Yoshihiro Kishida, Masao Yoshida, Sayo Ito, Noboru Kawata, Kenichiro Imai, Kinichi Hotta, Taisuke Imamura, Teiichi Sugiura, Katsuhiko Uesaka, Hiroyuki Ono
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Abstract

ABSTRACT Background and Objectives Endoscopic treatment of obstructive jaundice and pancreatitis due to hepaticojejunostomy (H-J), pancreatojejunostomy (P-J) strictures, and tumor recurrence after pancreatoduodenectomy (PD) is technically challenging. Treatment of P-J strictures results in poor outcomes. Although conventional EUS that has an oblique view is not suitable for such patients, forward-viewing EUS (FV-EUS) may become a useful option. This study aimed to evaluate the feasibility and efficacy of FV-EUS in patients who have undergone PD. Patients and methods Patients with PD who were scheduled to undergo diagnosis and treatment using FV-EUS for H-J or P-J lesions were enrolled in this single-center prospective study. After observation of the P-J and H-J using FV-EUS according to a predetermined protocol, treatment using FV-EUS was performed as needed. Results A total of 30 patients were enrolled, and FV-EUS was used to observe P-J and H-J in 24 and 28 patients, respectively. The detection rates of P-J and H-J by endoscopy were 50% (12/24) and 96.4% (27/28), respectively, and by EUS were 70.8% (17/24) and 100% (28/28), respectively. Of these, P-J and H-J were found by endoscopy only after EUS observation in 3 and 1 patient, respectively. The success rates of endoscopic treatment using FV-EUS were 66.7% (2/3), 95.2% (20/21), and 25% (1/4) for benign P-J strictures, benign H-J strictures, and tumor recurrence, respectively. Conclusions Endoscopic treatment using FV-EUS is feasible and effective for patients after PD. Moreover, FV-EUS increases the P-J lesion detection rate by adding EUS observation.
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前视超声内镜在胰十二指肠切除术后的临床应用:一项前瞻性研究
背景与目的内镜下治疗因肝空肠吻合术(H-J)、胰空肠吻合术(P-J)狭窄和胰十二指肠切除术(PD)后肿瘤复发引起的梗阻性黄疸和胰腺炎在技术上具有挑战性。P-J狭窄的治疗结果不佳。虽然斜位视图的传统EUS不适合此类患者,但前视EUS (FV-EUS)可能成为一种有用的选择。本研究旨在评价FV-EUS在PD患者中的可行性和疗效。患者和方法PD患者计划采用FV-EUS对H-J或P-J病变进行诊断和治疗,纳入本单中心前瞻性研究。按照预定方案使用FV-EUS观察P-J和H-J后,根据需要使用FV-EUS进行治疗。结果共纳入30例患者,FV-EUS分别观察24例P-J和28例H-J。P-J和H-J的内镜检出率分别为50%(12/24)和96.4% (27/28),EUS检出率分别为70.8%(17/24)和100%(28/28)。其中P-J和H-J分别有3例和1例患者在EUS观察后才通过内镜检查发现。内镜下FV-EUS治疗良性P-J狭窄、良性H-J狭窄和肿瘤复发的成功率分别为66.7%(2/3)、95.2%(20/21)和25%(1/4)。结论FV-EUS内镜下治疗PD是可行且有效的。FV-EUS通过增加EUS观察,提高了P-J病变检出率。
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来源期刊
Endoscopic Ultrasound
Endoscopic Ultrasound GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
6.20
自引率
11.10%
发文量
144
期刊介绍: Endoscopic Ultrasound, a publication of Euro-EUS Scientific Committee, Asia-Pacific EUS Task Force and Latin American Chapter of EUS, is a peer-reviewed online journal with Quarterly print on demand compilation of issues published. The journal’s full text is available online at http://www.eusjournal.com. The journal allows free access (Open Access) to its contents and permits authors to self-archive final accepted version of the articles on any OAI-compliant institutional / subject-based repository. The journal does not charge for submission, processing or publication of manuscripts and even for color reproduction of photographs.
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