单气囊小肠镜辅助内镜逆行胰管造影治疗胰肠吻合口狭窄的临床应用OA

Objective To evaluate the feasibility,effectiveness,and long-term outcome of single balloon enteroscopy(SBE)-assisted endoscopic retrograde pancreatography(ERP)in patients with pancreaticojejunal anastomotic stenosis(PJS).Methods The clinical data of 16 PJS cases undergoing SBE-assisted ERP from March 2016 to March 2021 were retrospectively reviewed.Technical and clinical success,adverse events,risk factors for failure and long-term outcomes were assessed.Results Eight of 16 patients were successfully treated,the success rate was 50%.No serious complications after ERP occurred.Risk factors for failure of pancreaticojejunostomy site identification included digestive tract Child reconstruction sequence(P=0.001),pancreaticojejunostomy method(P=0.001),without pancreatic duct support tube placement(P=0.037),undilated preoperative pancreatic duct(P=0.037)and postoperative pancreatic fistula(P=0.001).The interval between the first occurrence of abdominal pain after pancreaticoduodenectomy(PD)operation in the successful anastomotic site identification group was significantly longer than that in the failed group(44.7 months vs.19.9 months,P=0.044),while the time from symptom onset to the first ERP intervention was shorter than that in the anastomotic site identification failed group(8.4 months vs.22.4 months,P=0.021).During the follow-up periods[77.2(6.8,187.7)months],recurrence rates were 25%.The total duration of stent placement in 7 patients with endoscopic pancreatic drainage treatment was 62.3(6.8,153.7).Body mass index(BMI)variation is+2.46 kg/m2 in non-recurrence group compare to-1.09 kg/m2 in recurrence group and-2.12 kg/m2 in ERP treatment failure group.Conclusions SBE-assisted ERP treatment for PJS after PD showed favorable safety,effectiveness and durable long-term outcomes.ERP intervention should be carried out early once PJS occurs.BMI is an important index to be monitored during the follow-up of PJS patients.