Imoto Akira, Ogura Takeshi, Higuchi Kazuhide
Aoyama Hospital, Fujiidera, Osaka, Japan.
Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan.
Clin Endosc. 2020 Sep;53(5):525-534. doi: 10.5946/ce.2020.173. Epub 2020 Sep 24.
Endoscopic ultrasound-guided pancreatic duct drainage (EUS-PD) has emerged as an option in patients with failure of retrograde access to the pancreatic duct (PD) because of difficulty in cannulation or surgically altered anatomy. This article provides a comprehensive review of the techniques and outcomes of EUS-PD, especially EUS-guided pancreatic transmural stenting. The clinical data derived from a total of 401 patients were reviewed in which the overall technical and clinical success rates were 339/401 (85%, range 63%-100%) and 328/372 (88%, range 76%-100%), respectively. Short-term adverse events occurred in 25% (102/401) of the cases, which included abdominal pain (n=45), acute pancreatitis (n=17), bleeding (n=10), and issues associated with pancreatic juice leakage such as perigastric or peripancreatic fluid collection (n=9). In conclusion, although EUS-PD remains a challenging procedure with a high risk of adverse events such as pancreatic juice leakage, perforation, and severe acute pancreatitis, the procedure seems to be a promising alternative for PD drainage in patients with altered anatomy or unsuccessful endoscopic retrograde pancreatography.
内镜超声引导下胰管引流术（EUS-PD）已成为因插管困难或手术改变解剖结构而逆行进入胰管（PD）失败患者的一种选择。本文全面综述了EUS-PD的技术及结果，尤其是超声内镜引导下胰管经壁支架置入术。回顾了来自401例患者的临床资料，其中总体技术成功率和临床成功率分别为339/401（85%，范围63%-100%）和328/372（88%，范围76%-100%）。25%（102/401）的病例发生短期不良事件，包括腹痛（n=45）、急性胰腺炎（n=17）、出血（n=10）以及与胰液渗漏相关的问题，如胃周或胰周积液（n=9）。总之，尽管EUS-PD仍是一项具有挑战性的操作，存在胰液渗漏、穿孔和严重急性胰腺炎等不良事件的高风险，但该操作似乎是解剖结构改变或内镜逆行胰胆管造影术失败患者胰管引流的一种有前景的替代方法。
