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Abstract：
OBJECTIVE: Balloon endoscopy-assisted endoscopic retrograde cholangiopancreatography (BE-ERCP) is an emerging procedure for pancreatobiliary diseases in patients with surgically altered anatomy. However, data on BE-ERCP for hepatolithiasis after hepaticojejunostomy (HJS) are still limited.
METHODS: Stone removal success, adverse events and recurrence were retrospectively studied in consecutive patients who underwent BE-ERCP for hepatolithiasis after HJS between January 2011 and October 2022. Subgroup analysis was performed to compare clinical outcomes between patients who had undergone HJS over 10 years before (past HJS group) and within 10 years (recent HJS group).
RESULTS: A total of 131 patients were included; 39% had undergone HJS for malignancy and 32% for congenital biliary dilation. Scope insertion and complete stone removal were successful in 89% and 73%, respectively. Early adverse events were observed in 9.9%. Four patients (3.1%) developed gastrointestinal perforation but could be managed conservatively. Hepatolithiasis recurrence rate was 17%, 20% and 31% in 1-year, 3-year, and 5-year after complete stone removal. The past HJS group was the only risk factor for failed stone removal (odds ratio 10.4, 95% confidence interval 2.99-36.5) in the multivariable analysis. Failed scope insertion (20%) and failed guidewire or device insertion to the bile duct (22%) were two major reasons for failed stone removal in the past HJS group.
CONCLUSIONS: BE-ERCP for hepatolithiasis was effective and safe in cases with HJS but the complete stone removal rate was low in the past HJS group. Recurrent hepatolithiasis was common and careful follow up study is needed even after complete stone removal.
METHODS: Stone removal success, adverse events and recurrence were retrospectively studied in consecutive patients who underwent BE-ERCP for hepatolithiasis after HJS between January 2011 and October 2022. Subgroup analysis was performed to compare clinical outcomes between patients who had undergone HJS over 10 years before (past HJS group) and within 10 years (recent HJS group).
RESULTS: A total of 131 patients were included; 39% had undergone HJS for malignancy and 32% for congenital biliary dilation. Scope insertion and complete stone removal were successful in 89% and 73%, respectively. Early adverse events were observed in 9.9%. Four patients (3.1%) developed gastrointestinal perforation but could be managed conservatively. Hepatolithiasis recurrence rate was 17%, 20% and 31% in 1-year, 3-year, and 5-year after complete stone removal. The past HJS group was the only risk factor for failed stone removal (odds ratio 10.4, 95% confidence interval 2.99-36.5) in the multivariable analysis. Failed scope insertion (20%) and failed guidewire or device insertion to the bile duct (22%) were two major reasons for failed stone removal in the past HJS group.
CONCLUSIONS: BE-ERCP for hepatolithiasis was effective and safe in cases with HJS but the complete stone removal rate was low in the past HJS group. Recurrent hepatolithiasis was common and careful follow up study is needed even after complete stone removal.
摘要：
目的：球囊内镜辅助内镜逆行胰胆管造影术（BE-ERCP）是一种新兴的手术方法，用于手术解剖改变的胰胆管疾病。然而,关于肝空肠吻合术(HJS)后治疗肝胆管结石的BE-ERCP数据仍然有限.
方法：取石成功，我们对2011年1月至2022年10月因HJS术后肝胆管结石接受BE-ERCP治疗的连续患者的不良事件和复发情况进行了回顾性研究.进行亚组分析以比较10年前（过去的HJS组）和10年内（最近的HJS组）接受HJS的患者之间的临床结果。
结果：共纳入131例患者；39%因恶性肿瘤行HJS，32%因先天性胆道扩张行HJS。在89％和73％的范围内插入和完全取石成功，分别。早期不良事件发生率为9.9%。4例患者（3.1％）发生了胃肠道穿孔，但可以保守治疗。肝胆管结石复发率为17%,20%和31%在1年内，3年,和5年后完全清除结石。在多变量分析中，过去的HJS组是结石清除失败的唯一危险因素（比值比10.4，95％置信区间2.99-36.5）。在过去的HJS组中，内窥镜插入失败（20％）和导丝或设备插入胆管失败（22％）是结石清除失败的两个主要原因。
结论：BE-ERCP治疗HJS组的肝胆管结石是安全有效的，但HJS组的结石完全清除率较低。复发性肝胆管结石很常见，即使在完全清除结石后也需要仔细的随访研究。
方法：取石成功，我们对2011年1月至2022年10月因HJS术后肝胆管结石接受BE-ERCP治疗的连续患者的不良事件和复发情况进行了回顾性研究.进行亚组分析以比较10年前（过去的HJS组）和10年内（最近的HJS组）接受HJS的患者之间的临床结果。
结果：共纳入131例患者；39%因恶性肿瘤行HJS，32%因先天性胆道扩张行HJS。在89％和73％的范围内插入和完全取石成功，分别。早期不良事件发生率为9.9%。4例患者（3.1％）发生了胃肠道穿孔，但可以保守治疗。肝胆管结石复发率为17%,20%和31%在1年内，3年,和5年后完全清除结石。在多变量分析中，过去的HJS组是结石清除失败的唯一危险因素（比值比10.4，95％置信区间2.99-36.5）。在过去的HJS组中，内窥镜插入失败（20％）和导丝或设备插入胆管失败（22％）是结石清除失败的两个主要原因。
结论：BE-ERCP治疗HJS组的肝胆管结石是安全有效的，但HJS组的结石完全清除率较低。复发性肝胆管结石很常见，即使在完全清除结石后也需要仔细的随访研究。
