内镜超声引导肝胃造口术治疗恶性肝胆管阻塞的可行性。

IF 2.5 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Digestive Diseases and Sciences Pub Date : 2025-01-01 Epub Date: 2024-09-29 DOI:10.1007/s10620-024-08652-x
Akihisa Ohno, Nao Fujimori, Toyoma Kaku, Yuzo Shimokawa, Tsukasa Miyagahara, Yuta Suehiro, Anthony Gerodias, Shotaro Kakehashi, Kazuhide Matsumoto, Masatoshi Murakami, Keijiro Ueda, Yoshihiro Ogawa
{"title":"内镜超声引导肝胃造口术治疗恶性肝胆管阻塞的可行性。","authors":"Akihisa Ohno, Nao Fujimori, Toyoma Kaku, Yuzo Shimokawa, Tsukasa Miyagahara, Yuta Suehiro, Anthony Gerodias, Shotaro Kakehashi, Kazuhide Matsumoto, Masatoshi Murakami, Keijiro Ueda, Yoshihiro Ogawa","doi":"10.1007/s10620-024-08652-x","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Almost all previous reports on endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) involve malignant distal bile duct strictures. However, the feasibility of EUS-HGS for malignant hilar biliary obstruction (MHBO) remains unclear.</p><p><strong>Aims: </strong>This study aimed to evaluate the efficacy and safety of EUS-HGS for MHBO and identify the risk factors associated with technical failure.</p><p><strong>Methods: </strong>In this multicenter retrospective study, we reviewed consecutive patients who underwent EUS-HGS between April 2017 and March 2023 at five institutions. We assessed the overall feasibility and efficacy of EUS-HGS for MHBO, including the factors associated with technical failure, using multivariable logistic regression analysis.</p><p><strong>Results: </strong>A total of 85 patients were enrolled (mean age, 72 years; 36.4% female). Thirty-six patients (42.3%) had surgically altered anatomy, and 43 (50.6%) underwent biliary stenting by transpapillary or percutaneous biliary drainage before EUS-HGS. The rates of technical success, clinical success, and adverse events were 87.0% (74/85), 76.4% (65/85), and 11.8% (10/85), respectively. Multivariable analysis demonstrated that a bile duct diameter ≤ 4 mm was the only independent risk factor for technical failure (odds ratio, 6.12; 95% confidence interval, 1.02-36.6; P = 0.047). The most common reason for technical failure was cholangiography failure (45.4%), followed by inappropriate guidewire position (36.4%).</p><p><strong>Conclusions: </strong>EUS-HGS is a challenging but promising treatment option for MHBO. Patients with a bile duct diameter ≤ 4 mm or inappropriate guidewire position should be careful as these factors can lead to the technical failure of EUS-HGS for MHBO.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"419-428"},"PeriodicalIF":2.5000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Feasibility of Endoscopic Ultrasound-Guided Hepaticogastrostomy for Malignant Hilar Biliary Obstruction.\",\"authors\":\"Akihisa Ohno, Nao Fujimori, Toyoma Kaku, Yuzo Shimokawa, Tsukasa Miyagahara, Yuta Suehiro, Anthony Gerodias, Shotaro Kakehashi, Kazuhide Matsumoto, Masatoshi Murakami, Keijiro Ueda, Yoshihiro Ogawa\",\"doi\":\"10.1007/s10620-024-08652-x\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Almost all previous reports on endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) involve malignant distal bile duct strictures. However, the feasibility of EUS-HGS for malignant hilar biliary obstruction (MHBO) remains unclear.</p><p><strong>Aims: </strong>This study aimed to evaluate the efficacy and safety of EUS-HGS for MHBO and identify the risk factors associated with technical failure.</p><p><strong>Methods: </strong>In this multicenter retrospective study, we reviewed consecutive patients who underwent EUS-HGS between April 2017 and March 2023 at five institutions. We assessed the overall feasibility and efficacy of EUS-HGS for MHBO, including the factors associated with technical failure, using multivariable logistic regression analysis.</p><p><strong>Results: </strong>A total of 85 patients were enrolled (mean age, 72 years; 36.4% female). Thirty-six patients (42.3%) had surgically altered anatomy, and 43 (50.6%) underwent biliary stenting by transpapillary or percutaneous biliary drainage before EUS-HGS. The rates of technical success, clinical success, and adverse events were 87.0% (74/85), 76.4% (65/85), and 11.8% (10/85), respectively. Multivariable analysis demonstrated that a bile duct diameter ≤ 4 mm was the only independent risk factor for technical failure (odds ratio, 6.12; 95% confidence interval, 1.02-36.6; P = 0.047). The most common reason for technical failure was cholangiography failure (45.4%), followed by inappropriate guidewire position (36.4%).</p><p><strong>Conclusions: </strong>EUS-HGS is a challenging but promising treatment option for MHBO. Patients with a bile duct diameter ≤ 4 mm or inappropriate guidewire position should be careful as these factors can lead to the technical failure of EUS-HGS for MHBO.</p>\",\"PeriodicalId\":11378,\"journal\":{\"name\":\"Digestive Diseases and Sciences\",\"volume\":\" \",\"pages\":\"419-428\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Digestive Diseases and Sciences\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s10620-024-08652-x\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/9/29 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Digestive Diseases and Sciences","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10620-024-08652-x","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/9/29 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0

摘要

背景:以往关于内镜超声引导下肝胃切除术(EUS-HGS)的报道几乎都涉及恶性远端胆管狭窄。目的:本研究旨在评估 EUS-HGS 治疗恶性肝胆管梗阻(MHBO)的有效性和安全性,并确定与技术失败相关的风险因素:在这项多中心回顾性研究中,我们回顾了 2017 年 4 月至 2023 年 3 月期间在五家机构接受 EUS-HGS 的连续患者。我们采用多变量逻辑回归分析评估了 EUS-HGS 治疗 MHBO 的总体可行性和疗效,包括与技术失败相关的因素:共有 85 名患者入选(平均年龄 72 岁;36.4% 为女性)。36名患者(42.3%)的解剖结构经过手术改变,43名患者(50.6%)在 EUS-HGS 之前通过经胆道或经皮胆道引流术进行了胆道支架植入术。技术成功率、临床成功率和不良事件发生率分别为 87.0%(74/85)、76.4%(65/85)和 11.8%(10/85)。多变量分析表明,胆管直径≤4 毫米是技术失败的唯一独立风险因素(几率比,6.12;95% 置信区间,1.02-36.6;P = 0.047)。技术失败最常见的原因是胆管造影失败(45.4%),其次是导丝位置不当(36.4%):结论:EUS-HGS 是治疗 MHBO 的一种具有挑战性但前景广阔的方法。胆管直径小于 4 毫米或导丝位置不当的患者应谨慎,因为这些因素可能导致 EUS-HGS 治疗 MHBO 的技术失败。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
Feasibility of Endoscopic Ultrasound-Guided Hepaticogastrostomy for Malignant Hilar Biliary Obstruction.

Background: Almost all previous reports on endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) involve malignant distal bile duct strictures. However, the feasibility of EUS-HGS for malignant hilar biliary obstruction (MHBO) remains unclear.

Aims: This study aimed to evaluate the efficacy and safety of EUS-HGS for MHBO and identify the risk factors associated with technical failure.

Methods: In this multicenter retrospective study, we reviewed consecutive patients who underwent EUS-HGS between April 2017 and March 2023 at five institutions. We assessed the overall feasibility and efficacy of EUS-HGS for MHBO, including the factors associated with technical failure, using multivariable logistic regression analysis.

Results: A total of 85 patients were enrolled (mean age, 72 years; 36.4% female). Thirty-six patients (42.3%) had surgically altered anatomy, and 43 (50.6%) underwent biliary stenting by transpapillary or percutaneous biliary drainage before EUS-HGS. The rates of technical success, clinical success, and adverse events were 87.0% (74/85), 76.4% (65/85), and 11.8% (10/85), respectively. Multivariable analysis demonstrated that a bile duct diameter ≤ 4 mm was the only independent risk factor for technical failure (odds ratio, 6.12; 95% confidence interval, 1.02-36.6; P = 0.047). The most common reason for technical failure was cholangiography failure (45.4%), followed by inappropriate guidewire position (36.4%).

Conclusions: EUS-HGS is a challenging but promising treatment option for MHBO. Patients with a bile duct diameter ≤ 4 mm or inappropriate guidewire position should be careful as these factors can lead to the technical failure of EUS-HGS for MHBO.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Digestive Diseases and Sciences
Digestive Diseases and Sciences 医学-胃肠肝病学
CiteScore
6.40
自引率
3.20%
发文量
420
审稿时长
1 months
期刊介绍: Digestive Diseases and Sciences publishes high-quality, peer-reviewed, original papers addressing aspects of basic/translational and clinical research in gastroenterology, hepatology, and related fields. This well-illustrated journal features comprehensive coverage of basic pathophysiology, new technological advances, and clinical breakthroughs; insights from prominent academicians and practitioners concerning new scientific developments and practical medical issues; and discussions focusing on the latest changes in local and worldwide social, economic, and governmental policies that affect the delivery of care within the disciplines of gastroenterology and hepatology.
期刊最新文献
A Residual Laterally Spreading Tumor that Regressed After Chemotherapy Following Surgical Resection of Sigmoid Cancer. Are Non-invasive Multi-cancer Early Cancer Detection Tests the Future? Cholangioscope-Assisted Endoscopic Retrograde Appendicitis Therapy in the Management of Chronic Abdominal Pain Related to the Appendix: A Single-Center Retrospective Study. Results of Endoscopic Treatment of Recurrent Malignant Biliary Obstruction in Patients with Self-Expanding Metal Stents. Abbreviated Duration of Vasoactive Agents Has Similar Outcomes as Standard Duration of Therapy in Patients with Liver Cirrhosis and Variceal Bleeding: An Individual Patient Data Meta-Analysis.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1