Division of Endoscopy, Hokkaido University Hospital, Hokkaido, Japan.
Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Hokkaido, Japan.
Dig Endosc. 2022 Jan;34(2):334-344. doi: 10.1111/den.14006. Epub 2021 Jun 2.
Endoscopic biliary decompression is a minimally invasive procedure for cholestasis since the first endoscopic retrograde cholangiopancreatography-guided biliary stenting performed by Soehendra and Reynders-Frederix. Among the endoscopic biliary decompression, endoscopic transpapillary biliary stenting (EBS), is a mainstream choice and presently has two methods of placement: stenting above the sphincter of Oddi (SO) (suprapapillary) and stenting across the SO (transpapillary). Stent patency is the most important concern for patients, endoscopists and physicians because it can affect both the life prognosis and treatment schedule of patients. Biliary stent occlusion can occur because of several factors. Among them, direct food impaction, biofilm formation, and sludge formation play important roles and are presumed to be theoretically overcome by EBS above the SO. Thus, EBS above the SO is expected to result in a longer patency than EBS across the SO. In the literature, there have been six comparative studies on EBS for distal biliary obstruction in which the stent was placed above or across the SO, including two randomized controlled trials (RCTs) with negative results of stenting above the SO. With respect to EBS for hilar biliary obstruction, there have been no RCTs, whereas four retrospective comparative studies with negative results and four retrospective comparative studies showing positive results of stenting above the SO have been reported. In this review, we focused on EBS above and across the SO, and summarized the positive and negative results of the two types of stenting to promote effective clinical practice and to provide a basis for future studies.
内镜下胆管减压术是一种针对胆汁淤积的微创方法，自 Soehendra 和 Reynders-Frederix 首次进行内镜下逆行胰胆管造影引导下胆道支架置入术以来。在内镜下胆管减压术中，内镜下经乳头胆管支架置入术（EBS）是一种主流选择，目前有两种放置方法：Oddi 括约肌（SO）上方支架置入（经乳头）和 SO 下方支架置入（经乳头）。支架通畅性是患者、内镜医生和医生最关心的问题，因为它会影响患者的预后和治疗计划。胆管支架阻塞可能由多种因素引起。其中，直接食物嵌塞、生物膜形成和污泥形成起着重要作用，据推测，SO 上方的 EBS 可以在理论上克服这些问题。因此，SO 上方的 EBS 预计会比 SO 下方的 EBS 具有更长的通畅时间。在文献中，有六项关于远端胆管阻塞的 EBS 对比研究，其中支架放置在 SO 上方或下方，包括两项 SO 上方支架置入的阴性结果的随机对照试验（RCT）。关于肝门部胆管阻塞的 EBS，没有 RCT，只有四项阴性结果的回顾性对比研究和四项 SO 上方支架置入阳性结果的回顾性对比研究。在本综述中，我们重点关注 SO 上方和下方的 EBS，并总结了这两种支架的阳性和阴性结果，以促进有效的临床实践，并为未来的研究提供基础。
