Perez-Miranda Manuel, De la Serna-Higuera Carlos
Gastroenterology Department, Hospital Universitario Rio Hortega, Av. Dulzaina,2, 47012 Valladolid, Spain.
Curr Gastroenterol Rep. 2013 Oct;15(10):349. doi: 10.1007/s11894-013-0349-x.
EUS-guided biliary access procedures can target the gallbladder or the bile duct for drainage in selected cases. EUS-guided gallbladder drainage offers comparable results to percutaneous cholecystostomy in high-surgical risk patients with acute cholecystitis refractory to medical treatment. The procedure is not yet widely available. Novel lumen-apposing stents may improve long-term outcomes, resulting in rapid dissemination. EUS access to the bile duct is coupled with ERCP techniques into a hybrid procedure, endosono-cholangiopancreatography (ESCP). ESCP admits six variant approaches to bile duct drainage based on the combination of two access routes (intrahepatic and extrahepatic) with three drainage routes: transmural, retrograde transpapillary and antegrade transpapillary. A thousand ESCP cases have been reported to date with good outcomes. When the expertise is available, ESCP is increasingly replacing percutaneous transhepatic biliary drainage to provide biliary drainage in patients in whom ERCP is not feasible, predominantly in the setting of palliation, but not limited to it.
在特定病例中，超声内镜引导下的胆道穿刺引流术可针对胆囊或胆管进行引流。对于内科治疗无效、手术风险高的急性胆囊炎患者，超声内镜引导下的胆囊引流术与经皮胆囊造瘘术效果相当。该手术尚未广泛应用。新型管腔对接支架可能会改善长期疗效，从而得到迅速推广。超声内镜引导下进入胆管与内镜逆行胰胆管造影（ERCP）技术相结合，形成了一种混合手术——超声内镜下胰胆管造影（ESCP）。基于肝内和肝外两种穿刺途径与经壁、逆行经乳头和顺行经乳头三种引流途径的组合，ESCP有六种不同的胆管引流方法。迄今为止，已有1000例ESCP病例报告，效果良好。当具备相关专业技术时，ESCP越来越多地取代经皮经肝胆道引流术，为ERCP不可行的患者提供胆道引流，主要用于姑息治疗，但不限于此。
