目的:传入环路综合征(ALS)是胃肠道手术后的罕见不良事件,需要适当的早期减压治疗。已经尝试了几种内窥镜介入治疗,包括内窥镜肠内金属支架置入术(EMSP),内镜超声(EUS)引导下肠造口(EUS-EE),和EUS引导的肝胃造口术(EUS-HGS)。然而,关于结果的数据有限,包括支架通畅的持续时间。在这项研究中,我们评估了每次内镜下治疗恶性ALS的有效性.
方法:我们回顾性调查了9例接受EMSP治疗的恶性ALS患者,EUS-EE,或EUS-HGS。关于技术成功的信息,临床疗效,不良事件,支架功能障碍,收集并分析总生存期。
结果:最常见的症状是腹痛和胆管炎。ALS在三名患者中接受了EMSP治疗,三名患者的EUS-EE,和EUS-HGS在三名患者中。支架置入是成功的,并且在所有患者中都是临床有效的,没有不良事件。随访期间,在接受EUS-HGS治疗的两名患者中发生了支架功能障碍。在157天的中位随访中,有8名患者死于原发病。
结论:每种可用的恶性ALS的内镜干预措施都可以预期产生相似的结果,包括支架通畅的持续时间。内镜干预的选择应根据每种治疗的特点进行。
OBJECTIVE: Afferent loop syndrome (ALS) is a rare adverse event after gastrointestinal surgery requiring appropriate early decompression treatment. Several endoscopic interventions have been attempted for treatment, including endoscopic enteral metal stent placement (EMSP), endoscopic ultrasound (EUS)-guided entero-enterostomy (EUS-EE), and EUS-guided hepaticogastrostomy (EUS-HGS). However, there are limited data on outcomes, including duration of stent patency. In this study, we evaluated the usefulness of each endoscopic intervention for malignant ALS.
METHODS: We retrospectively investigated nine patients with malignant ALS who underwent EMSP, EUS-EE, or EUS-HGS. Information on technical success, clinical efficacy, adverse events, stent dysfunction, and overall survival was collected and analyzed.
RESULTS: The most common symptoms were abdominal pain and cholangitis. ALS was treated by EMSP in three patients, EUS-EE in three patients, and EUS-HGS in three patients. Stent placement was successful and clinically effective in all patients with no adverse events. During follow-up, stent dysfunction occurred in two patients treated by EUS-HGS. Eight patients died of primary disease during a median follow-up of 157 days.
CONCLUSIONS: Each of the available endoscopic interventions for malignant ALS can be expected to produce similar outcomes, including duration of stent patency. The choice of endoscopic intervention should be made based on the characteristics of each treatment.