PDF(Pubmed)
Abstract：
UNASSIGNED: Endoscopic ultrasound (EUS)-guided transhepatic antegrade stone removal (TASR) has been reserved for choledocholithiasis after failed endoscopic retrograde cholangiopancreatography (ERCP) in recent years. The aim of this study was to evaluate the techniques, feasibility, and safety of simplified single-session EUS-TASR for choledocholithiasis in patients with surgically altered anatomy (SAA).
UNASSIGNED: A retrospective database of patients with SAA and choledocholithiasis from the Second Hospital of Hebei Medical University (Shijiazhuang, China) between August 2020 and February 2023 was performed. They all underwent single-session EUS-TASR after ERCP failure. Basic characteristics of the patients and details of the procedures were collected. The success rates and adverse events were evaluated and discussed.
UNASSIGNED: During the study period, 13 patients underwent simplified single-session EUS-TASR as a rescue procedure (8 males, median age, 64.0 [IQR, 48.5-69.5] years). SAA consisted of four Whipple procedures, one Billroth II gastrectomy, four gastrectomy with Roux-en-Y anastomoses, and four hepaticojejunostomy with Roux-en-Y anastomoses. The technical success rate was 100% and successful bile duct stone removal was achieved in 12 of the patients (92.3%). Adverse events occurred in two patients (15.4%), while one turned to laparoscopic surgery and the other was managed conservatively.
UNASSIGNED: Simplified single-session EUS-TASR as a rescue procedure after ERCP failure appeared to be effective and safe in the management of choledocholithiasis in patients with SAA. But further evaluation of this technique is still needed, preferably through prospective multicenter trials.
UNASSIGNED: A retrospective database of patients with SAA and choledocholithiasis from the Second Hospital of Hebei Medical University (Shijiazhuang, China) between August 2020 and February 2023 was performed. They all underwent single-session EUS-TASR after ERCP failure. Basic characteristics of the patients and details of the procedures were collected. The success rates and adverse events were evaluated and discussed.
UNASSIGNED: During the study period, 13 patients underwent simplified single-session EUS-TASR as a rescue procedure (8 males, median age, 64.0 [IQR, 48.5-69.5] years). SAA consisted of four Whipple procedures, one Billroth II gastrectomy, four gastrectomy with Roux-en-Y anastomoses, and four hepaticojejunostomy with Roux-en-Y anastomoses. The technical success rate was 100% and successful bile duct stone removal was achieved in 12 of the patients (92.3%). Adverse events occurred in two patients (15.4%), while one turned to laparoscopic surgery and the other was managed conservatively.
UNASSIGNED: Simplified single-session EUS-TASR as a rescue procedure after ERCP failure appeared to be effective and safe in the management of choledocholithiasis in patients with SAA. But further evaluation of this technique is still needed, preferably through prospective multicenter trials.
摘要：
■近年来，内镜下逆行胰胆管造影术（ERCP）失败后，内镜超声（EUS）引导下经肝顺行取石（TASR）已被保留用于胆总管结石。这项研究的目的是评估技术，可行性,以及简化的单次EUS-TASR治疗手术解剖结构改变（SAA）的胆总管结石的安全性。
■河北医科大学第二医院的SAA和胆总管结石患者的回顾性数据库（石家庄，中国）在2020年8月至2023年2月期间执行。在ERCP失败后，他们都接受了单节EUS-TASR。收集患者的基本特征和手术细节。对成功率和不良事件进行评价和讨论。
■在研究期间，13例患者接受了简化的单次EUS-TASR作为抢救程序（8例男性，中位年龄,64.0[IQR，48.5-69.5]年）。SAA由四个Whipple程序组成,一次BillrothII胃切除术,用Roux-en-Y吻合术进行四次胃切除术，和四个肝空肠吻合术与Roux-en-Y吻合术。技术成功率为100％，其中12例（92.3％）成功清除了胆管结石。2例患者发生不良事件（15.4%），一个人转向腹腔镜手术，另一个人接受保守治疗。
■简化的单疗程EUS-TASR作为ERCP失败后的抢救程序在SAA患者的胆总管结石治疗中似乎是有效和安全的。但这项技术仍需进一步评估，最好通过前瞻性多中心试验。
■河北医科大学第二医院的SAA和胆总管结石患者的回顾性数据库（石家庄，中国）在2020年8月至2023年2月期间执行。在ERCP失败后，他们都接受了单节EUS-TASR。收集患者的基本特征和手术细节。对成功率和不良事件进行评价和讨论。
■在研究期间，13例患者接受了简化的单次EUS-TASR作为抢救程序（8例男性，中位年龄,64.0[IQR，48.5-69.5]年）。SAA由四个Whipple程序组成,一次BillrothII胃切除术,用Roux-en-Y吻合术进行四次胃切除术，和四个肝空肠吻合术与Roux-en-Y吻合术。技术成功率为100％，其中12例（92.3％）成功清除了胆管结石。2例患者发生不良事件（15.4%），一个人转向腹腔镜手术，另一个人接受保守治疗。
■简化的单疗程EUS-TASR作为ERCP失败后的抢救程序在SAA患者的胆总管结石治疗中似乎是有效和安全的。但这项技术仍需进一步评估，最好通过前瞻性多中心试验。
