Endoscopic Biliary Drainage in Surgically Altered Anatomy.
Endoscopic Biliary Drainage in Surgically Altered Anatomy.
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DOI：
10.3390/diagnostics13243623
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发表时间：
2023-12-08
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内窥镜逆行胰胆管造影术(ERCP)被认为是处理胆道梗阻的首选方法。然而，手术修改的解剖结构的流行经常构成挑战，使得标准的侧视十二指肠镜在大多数情况下无法到达乳头。外科解剖改变(SaaS)的增加是由于胰腺恶性肿瘤较高的减肥手术和外科干预的比率所致。当胃和十二指肠之间存在连续性时，使用侧视内窥镜的传统ERCP仍然有效。尽管如此，经皮经肝穿胆管引流术(PTBD)或外科手术历来被用作恶性或良性情况下胆道引流的替代方法。在不断演变的景观中，出现了各种根据解剖变化量身定做的内窥镜方法。创新的方法，如帽子辅助的前视内窥镜检查和肠镜检查，使ERCP的表现成为可能。尽管它们得到了利用，但出现了程序复杂、持续时间长和可获得性挑战。因此，人们对新型肠镜和内窥镜超声(EUS)技术越来越感兴趣，以确保内窥镜胆道引流的总体成功。值得注意的是，EUS已经使这一领域发生了革命性的变化，特别是通过审查中详细说明的几种技术。会合方法在这一领域起到了关键作用。顺行入路，包括胆道树穿刺术，允许以顺行的方式验证和治疗狭窄。EUS-穿壁入路包括连接胆道系统和胃肠道管腔。此外，EUS引导下的经胃ERCP(EDGE)手术结合了EUS和ERCP，为胃旁路术后提供了一种有前途的解决方案。这些进展为扩大全面和成功的胆道引流干预的视野提供了希望，为内窥镜手术的进一步发展奠定了基础。
Endoscopic retrograde cholangiopancreatography (ERCP) is considered the preferred method for managing biliary obstructions. However, the prevalence of surgically modified anatomies often poses challenges, making the standard side-viewing duodenoscope unable to reach the papilla in most cases. The increasing instances of surgically altered anatomies (SAAs) result from higher rates of bariatric procedures and surgical interventions for pancreatic malignancies. Conventional ERCP with a side-viewing endoscope remains effective when there is continuity between the stomach and duodenum. Nonetheless, percutaneous transhepatic biliary drainage (PTBD) or surgery has historically been used as an alternative for biliary drainage in malignant or benign conditions. The evolving landscape has seen various endoscopic approaches tailored to anatomical variations. Innovative methodologies such as cap-assisted forward-viewing endoscopy and enteroscopy have enabled the performance of ERCP. Despite their utilization, procedural complexities, prolonged durations, and accessibility challenges have emerged. As a result, there is a growing interest in novel enteroscopy and endoscopic ultrasound (EUS) techniques to ensure the overall success of endoscopic biliary drainage. Notably, EUS has revolutionized this domain, particularly through several techniques detailed in the review. The rendezvous approach has been pivotal in this field. The antegrade approach, involving biliary tree puncturing, allows for the validation and treatment of strictures in an antegrade fashion. The EUS-transmural approach involves connecting a tract of the biliary system with the GI tract lumen. Moreover, the EUS-directed transgastric ERCP (EDGE) procedure, combining EUS and ERCP, presents a promising solution after gastric bypass. These advancements hold promise for expanding the horizons of comprehensive and successful biliary drainage interventions, laying the groundwork for further advancements in endoscopic procedures.
影响因子：
3.9
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