Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan.
School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan.
Medicina (Kaunas). 2020 Mar 5;56(3):114. doi: 10.3390/medicina56030114.
Biliary and pancreatic cancers occur silently in the initial stage and become unresectable within a short time. When these diseases become symptomatic, biliary obstruction, either with or without infection, occurs frequently due to the anatomy associated with these cancers. The endoscopic management of these patients has changed, both with time and with improvements in medical devices. In this review, we present updated and integrated concepts for the endoscopic management of malignant biliary stricture. Endoscopic biliary drainage had been indicated in malignant biliary obstruction, but the concept of endoscopic management has changed with time. Although routine endoscopic stenting should not be performed in resectable malignant distal biliary obstruction (MDBO) patients, endoscopic biliary drainage is the treatment of choice for palliation in unresectable MDBO patients. Self-expanding metal stents (SEMS) have better stent patency and lower costs compared with plastic stents (PS). For malignant hilum obstruction, PS and uncovered SEMS yield similar short-term outcomes, while a covered stent is not usually used due to a potential unintentional obstruction of contralateral ducts.
肝胆管癌和胰腺癌在初期阶段隐匿发生，且在短时间内发展为不可切除。当这些疾病出现症状时，由于与这些癌症相关的解剖结构，常发生胆管阻塞，伴有或不伴有感染。随着时间的推移和医疗器械的改进，这些患者的内镜治疗也发生了变化。在这篇综述中，我们提出了更新和综合的概念，用于恶性胆管狭窄的内镜管理。在恶性胆管梗阻中，已经表明需要进行内镜胆管引流，但随着时间的推移，内镜管理的概念已经发生了变化。虽然在可切除的恶性远端胆管梗阻（MDBO）患者中不应该常规进行常规内镜支架置入，但内镜胆管引流是不可切除的 MDBO 患者缓解症状的首选治疗方法。与塑料支架（PS）相比，自膨式金属支架（SEMS）具有更好的支架通畅性和更低的成本。对于恶性肝门部梗阻，PS 和无覆盖的 SEMS 产生相似的短期结果，而由于潜在的对侧胆管意外阻塞，通常不使用覆盖支架。
