چکیده (انگلیسی):

Objective: Cholangiocarcinoma is common in Thailand. There are many palliative
treatments available for patients with unresectable tumor, such as endoscopic retrograde cholangiopancreatography
(ERCP) with stents, percutaneous transhepatic biliary drainage, or surgery.
In cases in which ERCP has failed, we propose an alternative technique: the use of
endoscopic ultrasound with fluoroscopy to perform hepaticogastrostomy for palliative drainage
instead of percutaneous transhepatic biliary drainage.
Patients and methods: A case series study was conducted between December 2005 and
December 2009 of 10 patients (4 male and 6 female, average age: 57 years) who presented
with severe jaundice caused by advanced cholangiocarcinoma, who were treated with this procedure
after failure to drain by ERCP. We used an electronic convex curved linear-array fluoroscopy-guided
echoendoscope to drain the left dilated intrahepatic duct to the stomach by
metallic wallstent. We performed the procedure with the first six patients under general anesthesia
and with the other four under conscious sedation. Follow-up liver function tests were
done, and clinical symptoms and survival times were recorded.
Results: Hepaticogastrostomy was unsuccessful on the first two patients (success rate Z 8/10;
80%), and effective drainage was obtained in only seven patients. Average total bilirubin
reduction was 14.96 mg/dL (58.75%) and 18.13 mg/dL (71.20%) after 2 weeks and 4 weeks,
respectively, with good quality of life. One patient was not effectively drained because of
malposition of the stent. There were two patients whose stent migrated into the stomach;
one needed a second session with a second wallstent, and the other needed a double pigtail
stent inside the second wallstent. Follow-up survival rates were 32e194 days (average: 123
days).
Conclusion: Endoscopic-ultrasound-guided hepaticogastrostomy is safe and can be a good palliative
option for advanced malignant biliary obstruction because it drains internally and is remote
from the tumor site, promoting a long patency period of prosthesis and better quality of life.