Ang Tiing Leong, Teo Eng Kiong, Fock Kwong Ming
Division of Gastroenterology, Department of Medicine, Changi General Hospital, Singapore, Singapore.
JOP. 2007 Jul 9;8(4):438-43.
Endoscopic transpapillary biliary drainage is the procedure of choice for biliary decompression in patients with unresectable pancreatic cancer. When ERCP is unsuccessful, the usual alternative is percutaneous transhepatic biliary drainage. Recently, the use of EUS-guided biliary drainage has been reported, but it is not clear whether it is feasible for this technique to find more widespread use as an alternative to failed ERCP. We herein describe our experience with two cases of unresectable pancreatic cancer associated with obstructive jaundice treated by EUS-guided biliary drainage.
Two men presented with obstructive jaundice due to unresectable pancreatic cancer. ERCP was unsuccessful in both cases because of complete tumor obstruction at the distal common bile duct. Both patients rejected the standard option of percutaneous transhepatic biliary drainage and EUS-guided biliary drainage was performed. The obstructed biliary system was successfully decompressed by the creation of a choledochoduodenal fistula and the insertion of a transduodenal biliary stent.
EUS-guided biliary drainage has the potential of replacing percutaneous transhepatic biliary drainage in unresectable pancreatic cancer with obstructive jaundice when ERCP is unsuccessful.
内镜下经乳头胆管引流术是不可切除胰腺癌患者胆管减压的首选方法。当内镜逆行胰胆管造影（ERCP）不成功时，通常的替代方法是经皮经肝胆管引流。最近，有报道使用超声内镜引导下胆管引流，但尚不清楚该技术作为ERCP失败的替代方法能否更广泛地应用。我们在此描述两例不可切除胰腺癌合并梗阻性黄疸患者接受超声内镜引导下胆管引流的经验。
两名男性因不可切除胰腺癌出现梗阻性黄疸。由于胆总管远端完全被肿瘤阻塞，两例患者的ERCP均未成功。两名患者均拒绝经皮经肝胆管引流的标准方案，而行超声内镜引导下胆管引流。通过建立胆总管十二指肠瘘和插入经十二指肠胆管支架，成功解除了梗阻性胆管系统。
当ERCP不成功时，超声内镜引导下胆管引流有可能替代经皮经肝胆管引流用于不可切除胰腺癌合并梗阻性黄疸的治疗。
