超声内镜引导下的肝胃造口术 (EUS-HGS) 是一种针对解剖结构改变或十二指肠狭窄患者的有效胆道引流技术。超声内镜引导下的肝空肠吻合术（EUS-HJS）可用于在有全胃切除史的患者的左肝管和空肠之间建立瘘管。尚未公布有关该技术的具体数据。本研究的目的是评估 EUS-HJS 在有全胃切除史的患者中的可行性和安全性。这项回顾性多中心研究包括 5 月份期间在三个法国三级中心和一个瑞士三级中心接受 EUS-HJS 的所有成年患者2011 年和 2023 年 2 月。主要结局是临床成功，定义为瘙痒、黄疸和/或胆管炎消失。手术后第一周内胆红素改善超过 30% 和/或手术后 1 个月内胆红素正常化也被认为是临床成功的指标。次要结局包括技术成功率、不良事件发生率、内镜翻修的需要、恢复抗癌治疗的可能性、中位生存期以及与 EUS-HGS 相比的技术差异。 共有 21 名患者通过 EUS-HJS 接受了全胃切除术被包括在内。 100% 的患者取得了技术成功（95% CI 85%-100%）。 80% 的患者取得了临床成功（95% CI 58%-92%）。记录的不良事件发生率为 33%（95% CI 17%-55%），其中胆管炎是最常见的并发症。七名患者（39%）在手术后能够从抗癌治疗中受益。中位生存期为 6 个月 (IQR 1.5-12)。EUS-HJS 对于解剖结构因全胃切除术而改变的患者来说是一种有效且可行的手术。版权所有 © 2024 美国胃肠内窥镜学会。由爱思唯尔公司出版。保留所有权利。

Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is an effective biliary drainage technique for patients with altered anatomy or duodenal strictures. Endoscopic ultrasound-guided hepaticojejunostomy (EUS-HJS) can be used to create a fistula between the left hepatic duct and the jejunum in patients with a history of total gastrectomy. No specific data on this technique have been published. The aim of this study was to assess the feasibility and safety of EUS-HJS in patients with a history of total gastrectomy.This retrospective multicenter study included all adult patients who underwent EUS-HJS at three tertiary French centers and one tertiary Swiss center between May 2011 and February 2023. The primary outcome was clinical success, which was defined as the disappearance of pruritus, jaundice and/or cholangitis. An improvement in bilirubin greater than 30% within the first week and/or bilirubin normalization within 1 month after the procedure were also considered indicators of clinical success. Secondary outcomes included technical success, the rate of adverse events, the need for endoscopic revision, the possibility of resuming anticancer treatment, median survival, and technical differences compared to EUS-HGS.A total of 21 patients who underwent complete gastrectomy via EUS-HJS were included. Technical success was achieved in 100% of patients (95% CI 85%-100%). Clinical success was achieved in 80% of patients (95% CI 58%-92%). The incidence of recorded adverse events was 33% (95% CI 17%-55%), with cholangitis being the most frequent complication. Seven patients (39%) were able to benefit from anticancer treatment after the procedure. The median survival was 6 months (IQR 1.5-12).EUS-HJS is an effective and feasible procedure for patients whose anatomy has been altered by total gastrectomy.Copyright © 2024 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.