Nakai Yousuke, Kogure Hirofumi, Isayama Hiroyuki, Koike Kazuhiko
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan.
Saudi J Gastroenterol. 2019 Jul-Aug;25(4):210-217. doi: 10.4103/sjg.SJG_474_18.
Endoscopic transpapillary or transanastomotic pancreatic duct drainage (PD) is the mainstay of drainage in symptomatic pancreatic duct obstruction or leakage. However, transpapillary or transanastomotic PD can be technically difficult due to the tight stricture or surgically altered anatomy (SAA), and endoscopic ultrasound (EUS)-guided PD (EUS-PD) is now increasingly used as an alternative technique. There are two approaches in EUS-PD: EUS-guided rendezvous (EUS-RV) and EUS-guided transmural drainage (EUS-TMD). In cases with normal anatomy, EUS-RV should be the first approach, whereas EUS-TMD can be selected in cases with SAA or duodenal obstruction. In our literature review, technical success and adverse event rates were 78.7% and 21.8%, respectively. The technical success rate of EUS-RV appeared lower than EUS-TMD due to the difficulty in guidewire passage. In future, development of dedicated devices and standardization of EUS-PD procedure are necessary.
内镜下经乳头或经吻合口胰管引流（PD）是有症状的胰管梗阻或漏液引流的主要方法。然而，由于狭窄紧密或手术改变的解剖结构（SAA），经乳头或经吻合口PD在技术上可能具有挑战性，而内镜超声（EUS）引导下的PD（EUS-PD）现在越来越多地被用作替代技术。EUS-PD有两种方法：EUS引导下会师（EUS-RV）和EUS引导下经壁引流（EUS-TMD）。在解剖结构正常的情况下，EUS-RV应作为首选方法，而在SAA或十二指肠梗阻的情况下可选择EUS-TMD。在我们的文献综述中，技术成功率和不良事件发生率分别为78.7%和21.8%。由于导丝通过困难，EUS-RV的技术成功率似乎低于EUS-TMD。未来，需要开发专用设备并使EUS-PD程序标准化。
