Abstract：
BACKGROUND: Endoscopic ultrasound-guided antegrade treatment (EUS-AG) and balloon endoscopy-assisted endoscopic retrograde cholangiopancreatography (BE-ERCP) have emerged as useful procedures for managing bile duct stones (BDS) in patients with surgically altered anatomy. However, the comparison between these two procedures has not been well studied. The aim of our study was to compare the clinical outcomes of EUS-AG and BE-ERCP for managing BDS in patients with surgically altered anatomy.
METHODS: The database was retrospectively evaluated at two tertiary care centers to identify patients with surgically altered anatomy who underwent either EUS-AG or BE-ERCP for BDS. Clinical outcomes were compared between the procedures. The success rate of each procedure was evaluated in three steps: endoscopic approach, biliary access, and stone extraction.
RESULTS: Among the 119 identified patients, 23 had EUS-AG, and 96 had BE-ERCP. The overall technical success rates of EUS-AG and BE-ERCP were 65.2% (15/23) and 69.8% (67/96), respectively (P = .80). The comparison of each step between the procedures EUS-AG versus BE-ERCP was as follows: endoscopic approach, 100% (23/23) versus 88.5% (85/96) (P = .11); biliary access, 73.9% (17/23) versus 80.0% (68/85) (P = .57); stone extraction, 88.2% (15/17) versus 98.5% (67/68) (P = .10). The overall adverse event rate was 17.4% (4/23) versus 7.3% (7/96) (P = .22).
CONCLUSIONS: Both EUS-AG and BE-ERCP are effective and relatively safe procedures in the management of BDS in patients with surgically altered anatomy. The challenging steps of each procedure might be different, which could help decide which one to use to manage BDS in patients with surgically altered anatomy.
METHODS: The database was retrospectively evaluated at two tertiary care centers to identify patients with surgically altered anatomy who underwent either EUS-AG or BE-ERCP for BDS. Clinical outcomes were compared between the procedures. The success rate of each procedure was evaluated in three steps: endoscopic approach, biliary access, and stone extraction.
RESULTS: Among the 119 identified patients, 23 had EUS-AG, and 96 had BE-ERCP. The overall technical success rates of EUS-AG and BE-ERCP were 65.2% (15/23) and 69.8% (67/96), respectively (P = .80). The comparison of each step between the procedures EUS-AG versus BE-ERCP was as follows: endoscopic approach, 100% (23/23) versus 88.5% (85/96) (P = .11); biliary access, 73.9% (17/23) versus 80.0% (68/85) (P = .57); stone extraction, 88.2% (15/17) versus 98.5% (67/68) (P = .10). The overall adverse event rate was 17.4% (4/23) versus 7.3% (7/96) (P = .22).
CONCLUSIONS: Both EUS-AG and BE-ERCP are effective and relatively safe procedures in the management of BDS in patients with surgically altered anatomy. The challenging steps of each procedure might be different, which could help decide which one to use to manage BDS in patients with surgically altered anatomy.
摘要：
内窥镜超声引导的顺行治疗（EUS-AG）和球囊内窥镜辅助的内窥镜逆行胰胆管造影（BE-ERCP）已成为治疗手术解剖结构改变的患者胆管结石（BDS）的有用程序。然而,这两种程序之间的比较还没有得到很好的研究。
目的：比较EUS-AG和BE-ERCP治疗手术解剖改变患者BDS的临床结果。
方法：在两个三级护理中心对数据库进行了回顾性评估，以确定因手术解剖结构改变而接受EUS-AG或BE-ERCP治疗BDS的患者。在手术之间比较临床结果。通过三个步骤评估每个程序的成功率：内窥镜入路，胆道通路,和石头提取。
结果：在119名确定的患者中，23有EUS-AG，96例患者有BE-ERCP。EUS-AG和BE-ERCP的总体技术成功率分别为65.2%(15/23)和69.8%(67/96),分别(p=0.80)。EUS-AG与程序之间的每个步骤的比较BE-ERCP如下：内镜入路，100%(23/23)vs.88.5%(85/96)(p=0.11);胆道通路,73.9％（17/23）与80.0%(68/85)(p=0.57)；结石提取，88.2%（15/17）与98.5%(67/68)(p=0.10)。总不良事件发生率为17.4%(4/23)。7.3%(7/96)(p=0.22)。
结论：EUS-AG和BE-ERCP在手术解剖改变的患者BDS治疗中都是有效且相对安全的方法。每个程序的挑战性步骤可能不同，这可以帮助决定使用哪一个来管理手术解剖改变的患者的BDS。
目的：比较EUS-AG和BE-ERCP治疗手术解剖改变患者BDS的临床结果。
方法：在两个三级护理中心对数据库进行了回顾性评估，以确定因手术解剖结构改变而接受EUS-AG或BE-ERCP治疗BDS的患者。
结果：在119名确定的患者中，
结论：EUS-AG和BE-ERCP在手术解剖改变的患者BDS治疗中都是有效且相对安全的方法。
