Transbulbäre und transgastrale Gallengangsdrainage

Die endoskopisch retrograde Cholangiopankreatikografie (ERCP) ist der Goldstandard für die Drainage der obstruktiven Cholestase maligner und benigner Erkrankungen, mit einer geringen Misserfolgsrate von 4–16% [1]. Bei fehlgeschlagener ERCP stehen verschiedene endosonografisch geführte Rescue-Verfahren (EUS-BD) zur Verfügung, deren Indikation und Durchführung im Folgenden vorgestellt werden.

Kernaussagen

• EUS-geführte biliäre Drainagen (EUS-BD) stellen eine Gruppe von „Rescue-Verfahren“ nach fehlgeschlagener ERCP dar.

• Sie ermöglichen einen direkten Zugang zu den Gallengängen vom Magen oder vom Duodenum aus, ohne dass die Papille zwingend erreicht werden muss.

• Transduodenal lassen sich der extrahepatische Ductus (hepato-)choledochus und transgastral intrahepatische Gallengänge im linken Leberlappen punktieren.

• Die Drainagenplatzierung am Zielort erfolgt entweder in Seldinger-Technik (prinzipiell für alle Verfahren realisierbar) oder als Direktpunktionsverfahren bei der EUS-gesteuerten Choledochoduodenostomie und Gallenblasendrainage.

• Die optimale Drainagestrategie richtet sich nach dem Ort der Obstruktion (distal/hilär) und der zugrunde liegenden Erkrankung (benigne/maligne).

• Es handelt sich um komplexe Verfahren, bei denen das Ergebnis maßgeblich durch die Fähigkeiten und Erfahrung des Untersuchers und der Expertise des Teams des gesamten Zentrums determiniert wird.

• Technische und klinische Erfolgsraten von 90% und darüber sind nach Datenlage erreichbar und stellen die Zielvorgabe dar.

• Je nach Verfahren ist mit Komplikationen in ca. 5–18% der Fälle zu rechnen. Diese sind in der Regel konservativ oder endoskopisch beherrschbar.

Schlüsselwörter

endoskopisch retrograd - Cholangiopankreatikografie - endoskopischer Ultraschall - biliäre Drainage - EUS-geführt

Publication History

Article published online:
20 March 2024

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