Salerno Raffaele, Davies Sophia Elizabeth Campbell, Mezzina Nicolò, Ardizzone Sandro
Gastroenterology and Digestive Endoscopy Unit, ASST Fatebenefratelli Sacco - Department of Biochemical and Clinical Sciences "L. Sacco", University of Milan, Milano 20100, Italy.
Hospital Pharmacy, ASST Fatebenefratelli Sacco, Piazza Principessa Clotilde, Milan 20121, Italy.
World J Gastrointest Endosc. 2019 May 16;11(5):354-364. doi: 10.4253/wjge.v11.i5.354.
Feasibility of endoscopic retrograde cholangiopancreatography (ERCP) for biliary drainage is not always applicable due to anatomical alterations or to inability to access the papilla. Percutaneous transhepatic biliary drainage has always been considered the only alternative for this indication. However, endoscopic ultrasonography-guided biliary drainage represents a valid option to replace percutaneous transhepatic biliary drainage when ERCP fails. According to the access site to the biliary tree, two kinds of approaches may be described: the intrahepatic and the extrahepatic. Endoscopic ultrasonography-guided rendez-vous transpapillary drainage is performed where the second portion of the duodenum is easily reached but conventional ERCP fails. The recent introduction of self-expandable metal stents and lumen-apposing metal stents has improved this field. However, the role of the latter is still controversial. Echoendoscopic transmural biliary drainage can be challenging with potential severe adverse events. Therefore, trained endoscopists, in both ERCP and endoscopic ultrasonography are needed with surgical and radiological backup.
由于解剖结构改变或无法到达乳头，内镜逆行胰胆管造影术（ERCP）用于胆道引流的可行性并非总是适用。经皮经肝胆道引流一直被认为是该适应症的唯一替代方法。然而，当ERCP失败时，内镜超声引导下胆道引流是替代经皮经肝胆道引流的有效选择。根据进入胆道树的部位，可描述两种方法：肝内和肝外。在内镜超声引导下经乳头会师引流术适用于十二指肠第二部易于到达但传统ERCP失败的情况。自膨式金属支架和管腔贴附金属支架的近期引入改善了这一领域。然而，后者的作用仍存在争议。超声内镜透壁胆道引流可能具有挑战性，且有潜在的严重不良事件。因此，需要训练有素的内镜医师进行ERCP和内镜超声检查，并要有外科和放射科的支持。
