Hamada Tsuyoshi, Isayama Hiroyuki, Nakai Yousuke, Kogure Hirofumi, Yamamoto Natsuyo, Koike Kazuhiko
J Hepatobiliary Pancreat Sci. 2014 Mar;21(3):E12-8. doi: 10.1002/jhbp.51.
Endoscopic placement of a self-expandable metal stent (SEMS) has become a mainstream treatment to relieve non-resectable distal malignant biliary obstructions—its longer patency and cost-effectiveness were demonstrated in comparison with plastic biliary stents in several randomized controlled trials. Despite advances in ERCP devices and SEMSs themselves to enable safe and effective biliary drainage via a SEMS, several significant aspects of the endoscopic placement of SEMS must be considered; otherwise, SEMS-related complications and early SEMS dysfunction may occur. Also, SEMS dysfunction, including occlusion and migration, occurs at a certain frequency in the long term, and appropriate reintervention is necessary to preserve the quality of life of the patient. Here, we present tips for endoscopic transpapillary SEMS placement for distal malignant biliary obstruction and reintervention for SEMS dysfunction.
内镜下放置自膨式金属支架（SEMS）已成为缓解不可切除的远端恶性胆管梗阻的主流治疗方法——在多项随机对照试验中，与塑料胆管支架相比，其通畅时间更长且具有成本效益。尽管内镜逆行胰胆管造影（ERCP）设备和SEMS本身取得了进展，能够通过SEMS实现安全有效的胆管引流，但必须考虑SEMS内镜放置的几个重要方面；否则，可能会发生与SEMS相关的并发症和早期SEMS功能障碍。此外，SEMS功能障碍，包括阻塞和移位，在长期内会以一定频率发生，需要进行适当的再次干预以维持患者的生活质量。在此，我们介绍远端恶性胆管梗阻内镜经乳头放置SEMS及SEMS功能障碍再次干预的技巧。
