- Hospital Mater Dei Santo Agostinho, Serviço de Endoscopia Digestiva - Belo Horizonte - MG - Brasil.
- Hospital das Clínicas da UFMG, Instituto Alfa de Gastroenterologia do Hospital das Clínicas da UFMG - Belo Horizonte - MG - Brasil.
Rev Col Bras Cir. 2023 Mar 27;50:e20233414. doi: 10.1590/0100-6991e-20233414-en. eCollection 2023.
Neoplasms of the biliopancreatic confluence may present with obstruction of the bile tract, leading to jaundice, pruritus and cholangitis. In these cases drainage of the bile tract is imperative. Endoscopic retrograde cholangiopancreatography (ERCP) with placement of a choledochal prosthesis is an effective treatment in about 90% of cases, even in experienced hands. In cases of ERCP failure, therapeutic options traditionally include surgical bypass by hepaticojejunostomy (HJ) or percutaneous transparietohepatic drainage (DPTH). In recent years, endoscopic ultrasound-guided biliary drainage techniques have gained space because they are less invasive, effective and have an acceptable incidence of complications. Endoscopic echo-guided drainage of the bile duct can be performed through the stomach (hepatogastrostomy), duodenum (choledochoduodenostomy) or by the anterograde drainage technique. Some services consider ultrasound-guided drainage of the bile duct the procedure of choice in the event of ERCP failure. The objective of this review is to present the main types of endoscopic ultrasound-guided biliary drainage and compare them with other techniques.
胆胰汇合部肿瘤可引起胆道梗阻，导致黄疸、瘙痒和胆管炎。在这些情况下，胆道引流是必要的。内镜逆行胰胆管造影术（ERCP）并置入胆管支架在约 90%的病例中是一种有效的治疗方法，即使在有经验的手中也是如此。在 ERCP 失败的情况下，传统的治疗选择包括通过肝肠吻合术（HJ）或经皮经肝穿刺引流（DPTH）进行手术旁路。近年来，内镜超声引导下胆道引流技术因其创伤性较小、疗效好且并发症发生率可接受而得到广泛应用。内镜超声引导下胆管引流可通过胃（胃-肝胆管吻合术）、十二指肠（胆管-十二指肠吻合术）或顺行引流技术进行。一些机构认为，在 ERCP 失败的情况下，超声引导下胆管引流是首选方法。本综述的目的是介绍主要类型的内镜超声引导下胆道引流，并将其与其他技术进行比较。
