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ERCP using balloon-assisted endoscopes versus EUS-guided treatment for common bile duct stones in Roux-en-Y gastrectomy - 16/01/24

Doi : 10.1016/j.gie.2023.09.001 
Tatsuya Sato, MD, PhD 1, Yousuke Nakai, MD, PhD 1, 2, ⁎, Hirofumi Kogure, MD, PhD 1, Toshiyuki Mitsuyama, MD, PhD 3, Masaaki Shimatani, MD, PhD 3, Shinya Uemura, MD, PhD 4, Takuji Iwashita, MD, PhD 4, Yuki Tanisaka, MD, PhD 5, Shomei Ryozawa, MD, PhD 5, Takayoshi Tsuchiya, MD, PhD 6, Takao Itoi, MD, PhD 6, Toshifumi Kin, MD, PhD 7, Akio Katanuma, MD, PhD 7, Ken Kashima, MD, PhD 8, Atsushi Irisawa, MD, PhD 8, Atsuto Kayashima, MD, PhD 9, Eisuke Iwasaki, MD, PhD 9, Akihiro Yoshida, MD, PhD 10, Mamoru Takenaka, MD, PhD 10, Hitomi Himei, MD, PhD 11, Hironari Kato, MD, PhD 11, Atsuhiro Masuda, MD, PhD 12, Hideyuki Shiomi, MD, PhD 12, 13, Kazumichi Kawakubo, MD, PhD 14, Masaki Kuwatani, MD, PhD 14, Takeshi Otsuka, MD, PhD 15, Saburo Matsubara, MD, PhD 15, Nobu Nishioka, MD, PhD 16, Takeshi Ogura, MD, PhD 16, Takaaki Tamura, MD, PhD 17, Masayuki Kitano, MD, PhD 17, Nobuhiko Hayashi, MD, PhD 18, Ichiro Yasuda, MD, PhD 18, Mitsuhiro Fujishiro, MD, PhD 1
1 Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan 
2 Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan 
3 Division of Gastroenterology and Hepatology, Kansai Medical University Medical Center, Osaka, Japan 
4 First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan 
5 Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan 
6 Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan 
7 Center for Gastroenterology, Teine Keijinkai Hospital, Hokkaido, Japan 
8 Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan 
9 Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan 
10 Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan 
11 Department of Gastroenterology and Hepatology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan 
12 Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Hyogo, Japan 
13 Division of Gastroenterology and Hepatobiliary and Pancreatic Diseases, Department of Internal Medicine, Hyogo Medical University, Hyogo, Japan 
14 Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Hokkaido, Japan 
15 Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan 
16 Endoscopy Center, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan 
17 Second Department of Internal Medicine, School of Medicine, Wakayama Medical University, Wakayama, Japan 
18 Third Department of Internal Medicine, University of Toyama, Toyama, Japan 

∗Reprint requests: Yousuke Nakai, MD, PhD, Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.Department of Endoscopy and Endoscopic SurgeryGraduate School of MedicineThe University of Tokyo7-3-1 HongoBunkyo-kuTokyo113-8655Japan

Abstract

Background and Aims

We compared ERCP using a balloon-assisted endoscope (BE-ERCP) with EUS-guided antegrade treatment (EUS-AG) for removal of common bile duct (CBD) stones in patients with Roux-en-Y (R-Y) gastrectomy.

Methods

Consecutive patients who had previous R-Y gastrectomy undergoing BE-ERCP or EUS-AG for CBD stones in 16 centers were retrospectively analyzed.

Results

BE-ERCP and EUS-AG were performed in 588 and 59 patients, respectively. Baseline characteristics were similar, except for CBD diameter and angle. The technical success rate was 83.7% versus 83.1% (P = .956), complete stone removal rate was 78.1% versus 67.8% (P = .102), and early adverse event rate was 10.2% versus 18.6% (P = .076) in BE-ERCP and EUS-AG, respectively. The mean number of endoscopic sessions was smaller in BE-ERCP (1.5 ± .8 vs 1.9 ± 1.0 sessions, P = .01), whereas the median total treatment time was longer (90 vs 61.5 minutes, P = .001). Among patients with biliary access, the complete stone removal rate was significantly higher in BE-ERCP (93.3% vs 81.6%, P = .009). Negative predictive factors were CBD diameter ≥15 mm (odds ratio [OR], .41) and an angle of CBD <90 degrees (OR, .39) in BE-ERCP and a stone size ≥10 mm (OR, .07) and an angle of CBD <90 degrees (OR, .07) in EUS-AG. The 1-year recurrence rate was 8.3% in both groups.

Conclusions

Effectiveness and safety of BE-ERCP and EUS-AG were comparable in CBD stone removal for patients after R-Y gastrectomy, but complete stone removal after technical success was superior in BE-ERCP.

Il testo completo di questo articolo è disponibile in PDF.

Abbreviations : AE, BE-ERCP, CBD, CI, EML, EPBD, EPLBD, EUS-AG, IQR, OR, R-Y


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© 2024  American Society for Gastrointestinal Endoscopy. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
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Vol 99 - N° 2

P. 193 - febbraio 2024 Ritorno al numero
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