Artifon E L A, Takada J, Okawa L, Ferreira F, Santos M, Moura E G H, Otoch J P, Sakai P
Endoscopy Unit, University of Sao Paulo, Sao Paulo, Brazil.
Rev Gastroenterol Mex. 2011 Jul-Sep;76(3):270-4.
Biliary endoscopic drainage using metallic self-expanded stents has become a well-established method for palliative treatment of malignant biliary obstruction. However, its occlusion, mainly by tumor overgrowth, is still the main complication without a standard treatment. We here describe a new method of treatment for biliary metallic stent occlusion, through the echo guided biliary drainage. We present a 68-year-old patient with metastatic pancreatic cancer previously treated for jaundice with ERCP and self-expandable metallic stent insertion. Four weeks later, the patient developed jaundice and symptoms of gastric outlet obstruction. A new ERCP confirmed obstruction of the second portion of the duodenum, due to diffuse tumor growth. EUS was performed, and the previous metal biliary stent was seen occluded at the distal portion in the common bile duct. A EUS-guided choledocododenostomy was performed and then, an overlapping self-expanding metal enteral stent was placed through the malignant obstruction. There were no early complications and the procedure was also clinically effective in relieving jaundice and gastric outlet obstruction symptoms. If ERCP fails in the management of occluded biliary metallic stents, EUS biliary drain can provide effective biliary decompression and should be considered an alternative to other endoscopic techniques.
使用金属自膨式支架进行胆道内镜引流已成为恶性胆道梗阻姑息治疗的一种成熟方法。然而，其闭塞主要是由于肿瘤过度生长，仍然是主要并发症且尚无标准治疗方法。我们在此描述一种通过超声引导胆道引流治疗胆道金属支架闭塞的新方法。我们介绍一位68岁的转移性胰腺癌患者，此前因黄疸接受了内镜逆行胰胆管造影术（ERCP）和自膨式金属支架置入治疗。四周后，患者出现黄疸和胃出口梗阻症状。再次行ERCP检查证实十二指肠第二部梗阻，原因是肿瘤弥漫性生长。进行了超声内镜检查（EUS），发现先前的金属胆道支架在胆总管远端闭塞。进行了超声内镜引导下胆总管十二指肠吻合术，然后通过恶性梗阻部位放置了一个重叠的自膨式金属肠道支架。无早期并发症，该手术在缓解黄疸和胃出口梗阻症状方面临床效果良好。如果ERCP在处理闭塞的胆道金属支架时失败，超声内镜引导下胆道引流可提供有效的胆道减压，应被视为其他内镜技术的替代方法。
