Nakai Yousuke, Kogure Hirofumi, Isayama Hiroyuki, Koike Kazuhiko
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan.
Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan.
Clin Endosc. 2019 May;52(3):220-225. doi: 10.5946/ce.2018.094. Epub 2018 Nov 29.
Endoscopic transpapillary biliary drainage is the current standard of care for unresectable hilar malignant biliary obstruction (MBO) and bilateral metal stent placement is shown to have longer patency. However, technical and clinical failure is possible and percutaneous transhepatic biliary drainage (PTBD) is sometimes necessary. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is increasingly being reported as an alternative rescue procedure to PTBD. EUS-BD has a potential advantage of not traversing the biliary stricture and internal drainage can be completed in a single session. Some approaches to bilateral biliary drainage for hilar MBO under EUS-guidance include a bridging method, hepaticoduodenostomy, and a combination of EUS-BD and transpapillary biliary drainage. The aim of this review is to summarize data on EUS-BD for hilar MBO and to clarify its advantages over the conventional approaches such as endoscopic transpapillary biliary drainage and PTBD.
内镜下经乳头胆管引流术是目前不可切除肝门部恶性胆管梗阻（MBO）的标准治疗方法，且已证实双侧金属支架置入的通畅时间更长。然而，该技术和临床治疗仍可能失败，有时需要行经皮经肝胆管引流术（PTBD）。越来越多的报道称，内镜超声引导下胆管引流术（EUS-BD）可作为PTBD的替代补救方法。EUS-BD的潜在优势在于不穿过胆管狭窄部位，且可在一次手术中完成内引流。在EUS引导下对肝门部MBO进行双侧胆管引流的一些方法包括桥接法、肝十二指肠吻合术以及EUS-BD与经乳头胆管引流术联合应用。本综述的目的是总结关于EUS-BD治疗肝门部MBO的数据，并阐明其相对于内镜下经乳头胆管引流术和PTBD等传统方法的优势。
