Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo, Japan.
Dig Endosc. 2024 May;36(5):546-553. doi: 10.1111/den.14756. Epub 2024 Mar 12.
The progress of endoscopic diagnosis and treatment for inflammatory diseases of the biliary tract and pancreas have been remarkable. Endoscopic ultrasonography (EUS) and EUS-elastography are used for the diagnosis of early chronic pancreatitis and evaluation of endocrine and exocrine function in chronic pancreatitis. Notably, extracorporeal shock wave lithotripsy and electrohydraulic shock wave lithotripsy have improved the endoscopic stone removal rate in patients for whom pancreatic stone removal is difficult. Studies have reported the use of self-expanding metal stents for stent placement for pancreatic duct stenosis and EUS-guided pancreatic drainage for refractory pancreatic duct strictures. Furthermore, EUS-guided drainage using a double-pigtailed plastic stent has been performed for the management of symptomatic pancreatic fluid collection after acute pancreatitis. Recently, lumen-apposing metal stents have led to advances in the treatment of walled-off necrosis after acute pancreatitis. EUS-guided biliary drainage is an alternative to refractory endoscopic biliary drainage and percutaneous transhepatic biliary drainage for the treatment of acute cholangitis. The placement of an inside stent followed by switching to uncovered self-expanding metal stents in difficult-to-treat cases has been proposed for acute cholangitis by malignant biliary obstruction. Endoscopic transpapillary gallbladder drainage is an alternative to percutaneous transhepatic gallbladder drainage for severe and some cases of moderate acute cholecystitis. EUS-guided gallbladder drainage has been reported as an alternative to percutaneous transhepatic gallbladder drainage and endoscopic transpapillary gallbladder drainage. However, it is important to understand the advantages and disadvantages of each drainage method and select the optimal drainage method for each case.
经内镜诊断和治疗胆道和胰腺炎性疾病已取得显著进展。超声内镜（EUS）和 EUS 弹性成像用于早期慢性胰腺炎的诊断和慢性胰腺炎内分泌和外分泌功能的评估。值得注意的是，体外冲击波碎石和液电冲击波碎石提高了胰腺结石取石困难患者的内镜取石率。有研究报道使用自膨式金属支架治疗胰管狭窄，EUS 引导胰腺引流治疗难治性胰管狭窄。此外，还采用双猪尾塑料支架进行 EUS 引导引流，以治疗急性胰腺炎后有症状的胰液积聚。最近，腔内置入金属支架在治疗急性胰腺炎后包裹性坏死方面取得了进展。EUS 引导胆道引流是治疗急性胆管炎的内镜下难治性胆道引流和经皮经肝胆道引流的替代方法。对于恶性胆道梗阻所致的急性胆管炎，提出了先放置内支架，然后在难治性病例中更换为 uncovered 自膨式金属支架的方法。经内镜逆行胰胆管造影术（ERCP）胆囊引流是治疗严重和某些中度急性胆囊炎的经皮经肝胆囊引流的替代方法。EUS 引导胆囊引流已被报道为经皮经肝胆囊引流和经内镜逆行胰胆管造影术（ERCP）胆囊引流的替代方法。然而，了解每种引流方法的优缺点，并为每个病例选择最佳的引流方法非常重要。
