Service of Gastroenterology and Hepatology, Geneva University Hospitals, Rue Micheli-du-Crest 24, Geneva, Switzerland.
Endoscopy. 2012 Mar;44(3):277-98. doi: 10.1055/s-0031-1291633. Epub 2012 Feb 1.
This article is part of a combined publication that expresses the current view of the European Society of Gastrointestinal Endoscopy about endoscopic biliary stenting. The present Clinical Guideline describes short-term and long-term results of biliary stenting depending on indications and stent models; it makes recommendations on when, how, and with which stent to perform biliary drainage in most common clinical settings, including in patients with a potentially resectable malignant biliary obstruction and in those who require palliative drainage of common bile duct or hilar strictures. Treatment of benign conditions (strictures related to chronic pancreatitis, liver transplantation, or cholecystectomy, and leaks and failed biliary stone extraction) and management of complications (including stent revision) are also discussed. A two-page executive summary of evidence statements and recommendations is provided. A separate Technology Review describes the models of biliary stents available and the stenting techniques, including advanced techniques such as insertion of multiple plastic stents, drainage of hilar strictures, retrieval of migrated stents and combined stenting in malignant biliary and duodenal obstructions.The target readership for the Clinical Guideline mostly includes digestive endoscopists, gastroenterologists, oncologists, radiologists, internists, and surgeons while the Technology Review should be most useful to endoscopists who perform biliary drainage.
本文是联合出版物的一部分,表达了欧洲胃肠道内镜学会目前对内镜胆道支架的看法。本临床指南描述了根据适应证和支架模型的胆道支架短期和长期结果;它就常见临床情况下何时、如何以及使用哪种支架进行胆道引流提出了建议,包括在有潜在可切除恶性胆道梗阻的患者和需要姑息性引流胆总管或肝门狭窄的患者中。还讨论了良性疾病(与慢性胰腺炎、肝移植或胆囊切除术相关的狭窄,以及漏和胆道取石失败)的治疗和并发症的处理(包括支架再处理)。提供了证据陈述和建议的两页执行摘要。单独的技术审查描述了现有的胆道支架模型和支架技术,包括插入多个塑料支架、肝门狭窄引流、迁移支架的取出以及恶性胆道和十二指肠梗阻的联合支架等先进技术。临床指南的目标读者主要包括消化内镜医师、胃肠病学家、肿瘤学家、放射科医师、内科医师和外科医师,而技术审查对进行胆道引流的内镜医师最有用。