| 抄録 |
AIM: Progression of malignant hilar biliary stricture leads to persistent obstructive jaundice, regardless of several efforts with endoscopic stenting. Although PTBD is performed in such advanced cases, its external drainage tube decreases patients' QOL. The aim of this study was to assess outcomes of EUS-guided hepaticogastrostomy (HGS) for treatment of malignant hilar biliary stricture. PATIENTS AND METHODS: A total of 23 patients with malignant hilar biliary stricture underwent EUS-guided hepaticogastrostomy after transpapillary drainage was ineffective or unsuccessful. After the left intrahepatic bile duct was punctured with EUS, a plastic or metallic stent was deployed to create hepaticogastrosotomy. The technical success, function success and complication rates were analyzed. RESULTS: Hilar biliary obstruction was caused by bile duct carcinoma, gallbladder carcinoma, hepatocellular carcinoma, lymph node and liver metastasis in 13, 2, 1, 4 and 3 patients, respectively. HGS was performed due to obstructive jaundice refractory to repeated transpapillary stenting in 12 patients. In the other 11 patients, ERCP had been unsuccessful. The technical success, clinical success and complication rates were 96%, 65% and 22%, respectively. In 14 of 15 cases with clinical success, re-intervention was not performed until patients' death. CONCLUSION: EUS-guided hepaticogastrostomy may be useful as an alternative drainage when transpapillary drainage was ineffective or unsuccessful in patients with malignant hilar biliary stricture. |
