ダブルバルーン内視鏡（DBE）下胆道処置不成功例に対する超音波内視鏡（EUS）ガイド下胆道治療の有用性
バルーン内視鏡の登場により，術後再建腸管症例に対する内視鏡的胆道治療は比較的容易になってきたが，処置困難例も存在する．一方，ERCP不成功例の代替治療として，超音波内視鏡（EUS）ガイド下胆道治療が報告され，術後再建腸管症例に対する有用性も報告されている．当院のダブルバルーン内視鏡（DBE）による胆道内視鏡治療不成功例に対するEUSガイド下胆道治療の有用性を検討した．EUSガイド下胆道治療を行った13例を対象とし，患者背景，手技成功率，平均手技時間，偶発症について検討した．手技成功率は100％（13/13例），偶発症は7.7％（1/13例）に認め，プラスチックステント逸脱を1例に認めた他には，...
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| Published in | Tando Vol. 30; no. 5; pp. 883 - 888 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本胆道学会
2016
Japan Biliary Association |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0914-0077 1883-6879 |
| DOI | 10.11210/tando.30.883 |
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| Abstract | バルーン内視鏡の登場により，術後再建腸管症例に対する内視鏡的胆道治療は比較的容易になってきたが，処置困難例も存在する．一方，ERCP不成功例の代替治療として，超音波内視鏡（EUS）ガイド下胆道治療が報告され，術後再建腸管症例に対する有用性も報告されている．当院のダブルバルーン内視鏡（DBE）による胆道内視鏡治療不成功例に対するEUSガイド下胆道治療の有用性を検討した．EUSガイド下胆道治療を行った13例を対象とし，患者背景，手技成功率，平均手技時間，偶発症について検討した．手技成功率は100％（13/13例），偶発症は7.7％（1/13例）に認め，プラスチックステント逸脱を1例に認めた他には，腹腔内気腫，胆汁性腹膜炎や出血などはみられなかった．DBE施行不成功例に対してEUSガイド下胆道治療は有用と思われた．しかし，EUSガイド下胆道治療が標準化されるにはまだ課題が多く，今後多施設での前向きな検討や専用デバイスの開発も待たれる． |
|---|---|
| AbstractList | バルーン内視鏡の登場により，術後再建腸管症例に対する内視鏡的胆道治療は比較的容易になってきたが，処置困難例も存在する．一方，ERCP不成功例の代替治療として，超音波内視鏡（EUS）ガイド下胆道治療が報告され，術後再建腸管症例に対する有用性も報告されている．当院のダブルバルーン内視鏡（DBE）による胆道内視鏡治療不成功例に対するEUSガイド下胆道治療の有用性を検討した．EUSガイド下胆道治療を行った13例を対象とし，患者背景，手技成功率，平均手技時間，偶発症について検討した．手技成功率は100％（13/13例），偶発症は7.7％（1/13例）に認め，プラスチックステント逸脱を1例に認めた他には，腹腔内気腫，胆汁性腹膜炎や出血などはみられなかった．DBE施行不成功例に対してEUSガイド下胆道治療は有用と思われた．しかし，EUSガイド下胆道治療が標準化されるにはまだ課題が多く，今後多施設での前向きな検討や専用デバイスの開発も待たれる． With the advent of balloon enteroscopy, we have come to be able to easily perform endoscopic biliary treatment (EBT) for patients with surgically altered anatomy (SAA).On the other hand, a good level of effectiveness for EUS-guided biliary treatment (EUS-BT) in failed ERCP cases has been reported. And it has also been reported that EUS-BT enables EBT even in difficult cases of SAA.We performed 13 EUS-BT's for patients with SAA, and these cases were all failed ERCP cases using double-balloon enteroscopy (DBE). This time, we retrospectively evaluated these cases. The technical success rate was 100% (13/13 cases). The complication rate was 7.7% (1/13 cases) and in that case plastic stent migration occured.In conclusion, EUS-BT is useful in cases when ERCP failed using DBE. Although we are faced with many tasks, it is hoped that EUS-BT will be a standard procedure in the near future. バルーン内視鏡の登場により，術後再建腸管症例に対する内視鏡的胆道治療は比較的容易になってきたが，処置困難例も存在する．一方，ERCP不成功例の代替治療として，超音波内視鏡（EUS）ガイド下胆道治療が報告され，術後再建腸管症例に対する有用性も報告されている．当院のダブルバルーン内視鏡（DBE）による胆道内視鏡治療不成功例に対するEUSガイド下胆道治療の有用性を検討した．EUSガイド下胆道治療を行った13例を対象とし，患者背景，手技成功率，平均手技時間，偶発症について検討した．手技成功率は100％（13/13例），偶発症は7.7％（1/13例）に認め，プラスチックステント逸脱を1例に認めた他には，腹腔内気腫，胆汁性腹膜炎や出血などはみられなかった．DBE施行不成功例に対してEUSガイド下胆道治療は有用と思われた．しかし，EUSガイド下胆道治療が標準化されるにはまだ課題が多く，今後多施設での前向きな検討や専用デバイスの開発も待たれる． |
| Author | 藤森, 崇行 山下, 拓磨 筒井, 邦彦 加藤, 清仁 小林, 聖幸 鎌田, 英紀 |
| Author_FL | Kato Kiyohito Yamashita Takuma Tsutsui Kunihiko Kobayashi Kiyoyuki Kamada Hideki Fujimori Takayuki |
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| DocumentTitleAlternate | The effectiveness of endoscopic ultrasonography-guided biliary treatment in failed ERCP cases using double-balloon enteroscopy |
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| References | 10) Stanley J, Gobien RP, Cunningham J, et al. Biliary decompression: an institutional comparison of percutaneous and endoscopic methods. Radiology 1986; 158: 195-197 11) Audisio RA, Morosi C, Bozzetti F, et al. The outcome of cholangitis after percutaneous biliary drainage in neoplastic jaundice. HPB Surg 1993; 6: 297-293 8) Katanuma A, Isayama H. Current status of endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy in Japan: questionnaire survey and important discussion points at Endoscopic Forum Japan 2013. Dig Endosc 2014; 26: 109-115 15) Giovannini M, Moutardier V, Pesenti C, et al. Endoscopic ultrasound-guided bilioduodenal anastomosis. Endoscopy 2001; 33: 898-900 6) Azeem N, Tabibian JH, Baron TH, et al. Use of a single-balloon enteroscope compared with variable-stiffness colonoscopies for endoscopic retrograde cholangiography in liver transplant patients with Roux-en-Y biliary anastomosis. Gastrointest Endosc 2013; 77: 568-577 17) Iwashita T, Yasuda I, Doi S, et al. Endoscopic ultrasound-guided antegrade treatments for biliary disorders in patients with surgically altered anatomy. Dig Dis Sci 2013; 58: 2017-2422 14) Takahashi Y, Nagino M, Ebata T, et al. Percutaneous transhepatic biliary drainage catheter tract recurrence in cholangiocarcinoma. British J Surg 2010; 97: 1860-1866 18) Itoi T, Sofuni A, Tsuchiya T, et al. Endoscopic ultrasonography-guided transhepatic antegrade stone removal in patients with surgically altered anatomy: case series and technical review (with videos). J Hepatobiliary Pancreat Sci 2014; 21: E86-E93 2) Itoi T, Ishii K, Sofuni A, et al. Long- and short-type double-balloon enteroscopy-assisted therapeutic ERCP for intact papilla in patients with a Roux-en-Y anastomosis. Surg Endosc 2011; 25: 713-721 1) Yamamoto H, Sekine Y, Sato Y, et al. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc 2001; 53: 216-220 9) Ishii K, Itoi T, Tonozuka R, et al. Balloon enteroscopy-assisted ERCP in patients with Roux-en-Y gastrectomy and intact papillae (with videos). Gastrointest Endosc 2016; 83: 377-386 7) Shah RJ, Smolkin M, Yen R, et al. A multicenter, U.S. experience of single-balloon, double-balloon, and rotational overtube-assisted enteroscope ERCP in patients with surgically altered pancreaticobiliary anatomy (with video). Gastrointest Endosc 2013; 77: 593-600 13) Leng JJ, Zhang N, Dong JH. Percutaneous transhepatic and endoscopic biliary drainage for malignant biliary tract obstruction: a meta-analysis. World J Surg Oncol 2014; 12: 272 16) Iwashita T, Doi S, Yasuda I, et al. Endoscopic ultrasound-guided biliary drainage: a review. Clin J Gastroenterol 2014; 7: 94-102 12) Garcarek J, Kurcz J, Guzinski M, et al. Ten years single center experience in percutaneous transhepatic decompression of biliary tree in patients with malignant obstructive jaundice. Adv Clin Exp Med 2013; 21: 621-632 4) Schreiner MA, Chang L, Gluck M, et al. Laparoscopy-assisted versus balloon enteroscopy-assisted ERCP in bariatric post-Roux-en-Y gastric bypass patients. Gastrointest Endosc 2012; 75: 748-756 19) Siripun A, Sripongpun P, Ovartiarnporn B. Endoscopic ultrasound-guided biliary intervention in patients with surgically altered anatomy. World J Gastrointest Endosc 2015; 7: 283-289 5) Yamauchi H, Kida M, Okuwaki K, et al. Short-type single balloon enteroscope for endoscopic retrograde cholangiopancreatography with altered gastrointestinal anatomy. World J Gastroenterol 2013; 19: 1728-1735 3) Shimatani M, Matsushita M, Takaoka M, et al. Effective "short" double-balloon enteroscope for diagnostic and therapeutic ERCP in patients with altered gastrointestinal anatomy. Endoscopy 2009; 41: 849-854 20) Iwashita T, Nakai Y, Hara K, et al. Endoscopic ultrasound-guided antegrade treatment of bile duct stone in patients with surgically altered anatomy: a multicenter retrospective cohort study. J Hepatobiliary Pancreat Sci 2016; 23: 227-233 |
| References_xml | – reference: 2) Itoi T, Ishii K, Sofuni A, et al. Long- and short-type double-balloon enteroscopy-assisted therapeutic ERCP for intact papilla in patients with a Roux-en-Y anastomosis. Surg Endosc 2011; 25: 713-721 – reference: 6) Azeem N, Tabibian JH, Baron TH, et al. Use of a single-balloon enteroscope compared with variable-stiffness colonoscopies for endoscopic retrograde cholangiography in liver transplant patients with Roux-en-Y biliary anastomosis. Gastrointest Endosc 2013; 77: 568-577 – reference: 9) Ishii K, Itoi T, Tonozuka R, et al. Balloon enteroscopy-assisted ERCP in patients with Roux-en-Y gastrectomy and intact papillae (with videos). Gastrointest Endosc 2016; 83: 377-386 – reference: 8) Katanuma A, Isayama H. Current status of endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy in Japan: questionnaire survey and important discussion points at Endoscopic Forum Japan 2013. Dig Endosc 2014; 26: 109-115 – reference: 14) Takahashi Y, Nagino M, Ebata T, et al. Percutaneous transhepatic biliary drainage catheter tract recurrence in cholangiocarcinoma. British J Surg 2010; 97: 1860-1866 – reference: 19) Siripun A, Sripongpun P, Ovartiarnporn B. Endoscopic ultrasound-guided biliary intervention in patients with surgically altered anatomy. World J Gastrointest Endosc 2015; 7: 283-289 – reference: 20) Iwashita T, Nakai Y, Hara K, et al. Endoscopic ultrasound-guided antegrade treatment of bile duct stone in patients with surgically altered anatomy: a multicenter retrospective cohort study. J Hepatobiliary Pancreat Sci 2016; 23: 227-233 – reference: 15) Giovannini M, Moutardier V, Pesenti C, et al. Endoscopic ultrasound-guided bilioduodenal anastomosis. Endoscopy 2001; 33: 898-900 – reference: 1) Yamamoto H, Sekine Y, Sato Y, et al. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc 2001; 53: 216-220 – reference: 3) Shimatani M, Matsushita M, Takaoka M, et al. Effective "short" double-balloon enteroscope for diagnostic and therapeutic ERCP in patients with altered gastrointestinal anatomy. Endoscopy 2009; 41: 849-854 – reference: 11) Audisio RA, Morosi C, Bozzetti F, et al. The outcome of cholangitis after percutaneous biliary drainage in neoplastic jaundice. HPB Surg 1993; 6: 297-293 – reference: 16) Iwashita T, Doi S, Yasuda I, et al. Endoscopic ultrasound-guided biliary drainage: a review. Clin J Gastroenterol 2014; 7: 94-102 – reference: 5) Yamauchi H, Kida M, Okuwaki K, et al. Short-type single balloon enteroscope for endoscopic retrograde cholangiopancreatography with altered gastrointestinal anatomy. World J Gastroenterol 2013; 19: 1728-1735 – reference: 7) Shah RJ, Smolkin M, Yen R, et al. A multicenter, U.S. experience of single-balloon, double-balloon, and rotational overtube-assisted enteroscope ERCP in patients with surgically altered pancreaticobiliary anatomy (with video). Gastrointest Endosc 2013; 77: 593-600 – reference: 13) Leng JJ, Zhang N, Dong JH. Percutaneous transhepatic and endoscopic biliary drainage for malignant biliary tract obstruction: a meta-analysis. World J Surg Oncol 2014; 12: 272 – reference: 12) Garcarek J, Kurcz J, Guzinski M, et al. Ten years single center experience in percutaneous transhepatic decompression of biliary tree in patients with malignant obstructive jaundice. Adv Clin Exp Med 2013; 21: 621-632 – reference: 10) Stanley J, Gobien RP, Cunningham J, et al. Biliary decompression: an institutional comparison of percutaneous and endoscopic methods. Radiology 1986; 158: 195-197 – reference: 4) Schreiner MA, Chang L, Gluck M, et al. Laparoscopy-assisted versus balloon enteroscopy-assisted ERCP in bariatric post-Roux-en-Y gastric bypass patients. Gastrointest Endosc 2012; 75: 748-756 – reference: 17) Iwashita T, Yasuda I, Doi S, et al. Endoscopic ultrasound-guided antegrade treatments for biliary disorders in patients with surgically altered anatomy. Dig Dis Sci 2013; 58: 2017-2422 – reference: 18) Itoi T, Sofuni A, Tsuchiya T, et al. Endoscopic ultrasonography-guided transhepatic antegrade stone removal in patients with surgically altered anatomy: case series and technical review (with videos). J Hepatobiliary Pancreat Sci 2014; 21: E86-E93 |
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| SubjectTerms | balloon enteroscopy biliary drainage EUS surgically altered anatomy バルーン内視鏡 胆道ドレナージ 術後再建腸管 超音波内視鏡（EUS） |
| Title | ダブルバルーン内視鏡（DBE）下胆道処置不成功例に対する超音波内視鏡（EUS）ガイド下胆道治療の有用性 |
| URI | https://www.jstage.jst.go.jp/article/tando/30/5/30_883/_article/-char/ja https://cir.nii.ac.jp/crid/1390282679327015424 |
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