Comparison of intraductal ultrasonographydirected and cholangiography-directed endoscopic retrograde biliary drainage in patients with a biliary obstruction
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background/Aims: Endoscopic retrograde biliary drainage (ERBD) has become a standard procedure in patients with a biliary obstruction. Intraductal ultrasonography (IDUS) has emerged as a new tool for managing extrahepatic biliary diseases. IDUS-directed ERBD can be performed without conventional cholangiography (CC). The goal of this study was to assess the effectiveness and safety of IDUS-directed ERBD compared to CC-directed ERBD in patients with an extrahepatic biliary obstruction. Methods: A total of 210 patients who had undergone IDUS-directed ERBD (IDUS-ERBD, n = 105) and CC-directed ERBD (CC-ERBD, n = 105) between October 2013 and April 2014 were analyzed retrospectively. The primary outcome measure was the procedural success rate. Secondary outcome measures included clinical outcomes, total procedure time, radiation exposure time, and overall complication rates. Results: The total technical success rate of ERBD was 100% (105/105) in the IDUSERBD and CC-ERBD groups. Mean procedure time was slightly prolonged in the IDUS-ERBD group than that in the CC-ERBD group (32.1 ± 9.9 minutes vs. 28.4 ± 11.6 minutes, p = 0.023). Mean radiation exposure time was one-third less in the IDUS-ERBD group than that in the CC-ERBD group (28.0 ± 49.3 seconds vs. 94.2 ± 57.3 seconds, p < 0.001). No significant differences in complication rates were detected between the groups. Conclusions: IDUS-ERBD was equally effective and safe as CC-ERBD in patients with an extrahepatic biliary obstruction. Although IDUS-ERBD increased total procedure time, it significantly decreased radiation exposure.
Abstract
Background/Aims: Endoscopic retrograde biliary drainage (ERBD) has become a standard procedure in patients with a biliary obstruction. Intraductal ultrasonography (IDUS) has emerged as a new tool for managing extrahepatic biliary diseases. IDUS-directed ERBD can be performed without conventional cholangiography (CC). The goal of this study was to assess the effectiveness and safety of IDUS-directed ERBD compared to CC-directed ERBD in patients with an extrahepatic biliary obstruction. Methods: A total of 210 patients who had undergone IDUS-directed ERBD (IDUS-ERBD, n = 105) and CC-directed ERBD (CC-ERBD, n = 105) between October 2013 and April 2014 were analyzed retrospectively. The primary outcome measure was the procedural success rate. Secondary outcome measures included clinical outcomes, total procedure time, radiation exposure time, and overall complication rates. Results: The total technical success rate of ERBD was 100% (105/105) in the IDUSERBD and CC-ERBD groups. Mean procedure time was slightly prolonged in the IDUS-ERBD group than that in the CC-ERBD group (32.1 ± 9.9 minutes vs. 28.4 ± 11.6 minutes, p = 0.023). Mean radiation exposure time was one-third less in the IDUS-ERBD group than that in the CC-ERBD group (28.0 ± 49.3 seconds vs. 94.2 ± 57.3 seconds, p < 0.001). No significant differences in complication rates were detected between the groups. Conclusions: IDUS-ERBD was equally effective and safe as CC-ERBD in patients with an extrahepatic biliary obstruction. Although IDUS-ERBD increased total procedure time, it significantly decreased radiation exposure.
참고문헌 (25)
- Artifon EL, "Bile duct stone extraction under endoscopic ultrasound guidance without fluoroscopy or contrast injection", Endoscopy, 40(Suppl 2), pp.E13~E14 (2008)
- Campbell N, "Practical radiation safety and protection for the endoscopist during ERCP", Gastrointest Endosc Clin N Am, 55, pp.552~557 (2002)
- Cotton PB, "Endoscopic sphincterotomy complications and their management: an attempt at consensus", Gastrointest Endosc, 37, pp.383~393 (1991)
- Kundu R, "Clinical application of intraductal ultrasound during endoscopic retrograde cholangiopancreatography", Gastrointest Endosc Clin N Am, 19, pp.615~628 (2009)
- Kuroiwa M, "Intraductal ultrasonography for the diagnosis of proximal invasion in extrahepatic bile duct cancer", J Gastroenterol Hepatol, 13, pp.715~719 (1998)
- Lee JM, "Intraductal ultrasonography-directed endoscopic retrograde biliary drainage without fluoroscopy", Endoscopy, 46(Suppl 1 UCTN), pp.E495~ (2014)
- 임성옥, "Intraductal Ultrasonography without Radiocontrast Cholangiogram in Patients with Extrahepatic Biliary Disease", Gut and Liver, 9(4), pp.540~546 (2015), 거트앤리버 발행위원회
- Lorenzo-Zuniga V, "Predictive factors of radiation dose in ERCP: a prospective study in 2 tertiary centers", Surg Laparosc Endosc Percutan Tech, 23, pp.266~270 (2013)
- Menzel J, "Preoperative diagnosis of bile duct strictures: comparison of intraductal ultrasonography with conventional endosonography", Scand J Gastroenterol, 35, pp.77~82 (2000)
- Misra SP, "Endoscopic sphincterotomy, nasobiliary drainage and biliary stent placement without image intensification", Br J Surg, 79, pp.1179~1180 (1992)
- Moon JH, "The detection of bile duct stones in suspected biliary pancreatitis: comparison of MRCP, ERCP, and intraductal US", Am J Gastroenterol, 100, pp.1051~1057 (2005)
- Palazzo L, "Which test for common bile duct stones? Endoscopic and intraductal ultrasonography", Endoscopy, 29, pp.655~665 (1997)
- Pisello F, "Cholangitis prevention in endoscopic Klatskin tumor palliation:air cholangiography technique", Langenbecks Arch Surg, 394, pp.1109~1114 (2009)
- Katayama H, "Adverse reactions to ionic and nonionic contrast media: a report from the Japanese Committee on the Safety of Contrast Media", Radiology, 175, pp.621~628 (1990)
- Ladas SD, "Absorption of iodized contrast media during ERCP", Gastrointest Endosc Clin N Am, 32, pp.376~ (1986)
- Draganov P, "Iodinated contrast sensitivity in ERCP", Am JGastroenterol, 95, pp.1398~1401 (2000)
- Schofl R, "Diagnostic endoscopic retrograde cholangiopancreatography", Endoscopy, 33, pp.147~157 (2001)
- Schorn TF, "Ultrasound-guided emergency endoscopic retrograde biliary drainage without radiography", Endoscopy, 29, pp.232~233 (1997)
- Tamada K, "Transpapillary intraductal US prior to biliary drainage in the assessment of longitudinal spread of extrahepatic bile duct carcinoma", Gastrointest Endosc, 53, pp.300~307 (2001)
- Tamada K, "Characterization of biliary strictures using intraductal ultrasonography : comparison with percutaneous cholangioscopic biopsy", Gastrointest Endosc, 47, pp.341~349 (1998)
- Tsapaki V, "Patient and endoscopist radiation doses during ERCP procedures", Radiat Prot Dosimetry, 147, pp.111~113 (2011)
- Ito K, "Preoperative evaluation of ampullary neoplasm with EUS and transpapillary intraductal US: a prospective and histopathologically controlled study", Gastrointest Endosc, 66, pp.740~747 (2007)
- Wang HP, "Urgent endoscopic nasobiliary drainage without fluoroscopic guidance: a useful treatment for critically ill patients with biliary obstruction", Gastrointest Endosc, 52, pp.741~744 (2000)
- Perez-Miranda M, "Endosonography-guided cholangiopancreatography as a salvage drainage procedure for obstructed biliary and pancreatic ducts", World J Gastrointest Endosc, 2, pp.212~222 (2010)
- Tarantino I, "Endoscopic ultrasound guided biliary drainage", World J Gastrointest Endosc, 4, pp.306~311 (2012)