Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
Gut Liver. 2013 Mar;7(2):129-36. doi: 10.5009/gnl.2013.7.2.129. Epub 2012 Nov 13.
Endoscopic retrograde cholangiopancreatography (ERCP) has become the first-line therapy for bile duct drainage. In the hands of experienced endoscopists, conventional ERCP results in a failed cannulation rate of 3% to 5%. This failure can occur more commonly in the setting of altered anatomy or technically difficult cases due to either duodenal or biliary obstruction. In cases of ERCP failure, patients have traditionally been referred for either percutaneous transhepatic biliary drainage (PTBD) or surgery. However, both PTBD and surgery have higher than desirable complication rates. Within the last decade, endoscopic ultrasound-guided biliary drainage (EUS-BD) has become an attractive alternative to PTBD after failed ERCP. Many groups have reported on the feasibility, efficacy and safety of this technique. This article reviews the indications for ERCP and the currently practiced EUS-BD techniques, including EUS-guided rendezvous, EUS-guided choledochoduodenostomy and EUS-guided hepaticogastrostomy.
经内镜逆行胰胆管造影术（ERCP）已成为胆管引流的一线治疗方法。在有经验的内镜医生手中，常规 ERCP 的失败率为 3%至 5%。这种失败在解剖结构改变或因十二指肠或胆道阻塞而技术上困难的情况下更为常见。在 ERCP 失败的情况下，患者传统上被转诊进行经皮经肝胆管引流（PTBD）或手术。然而，PTBD 和手术的并发症发生率都高于理想水平。在过去十年中，内镜超声引导下胆道引流（EUS-BD）已成为 ERCP 失败后的一种有吸引力的替代 PTBD 的方法。许多小组已经报告了这项技术的可行性、疗效和安全性。本文回顾了 ERCP 的适应证和目前实践的 EUS-BD 技术，包括 EUS 引导下会师技术、EUS 引导下胆肠吻合术和 EUS 引导下肝胃吻合术。
