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DOI: 10.1055/s-0041-1731266
Advancements in Endoscopic Biliary Interventions by Gastroenterology
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Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic technique in which a specialized side-viewing endoscope is guided into the duodenum, allowing for instruments to access the biliary and pancreatic ducts. ERCP was initially developed as a diagnostic tool as computed tomography was in its infancy during that time. ERCP has evolved since its inception in the 1960s to becoming not only a valuable diagnostic resource but now an effective therapeutic intervention in the treatment of various biliary disorders. The most common biliary interventions performed by ERCP include the management of biliary obstructions for benign and malignant indications. Additionally, endoscopic ultrasound (EUS) has been increasingly utilized in diagnosing and intervening on pancreaticobiliary lesion. This article will discuss the various methods currently available for various endoscopic biliary interventions and future interventional techniques. For the management of biliary strictures, EUS can be utilized with fine need aspiration, while ERCP can be used for the placement of various stents and diagnostic modalities. Another example is radiofrequency ablation, which can be used for the treatment of hilar strictures. Achieving bile duct access can be challenging in patients with complicated clinical scenarios; other techniques that can be used for bile duct access include EUS-guided rendezvous approach, transluminal approach, Choleodochoduodenostomy, and hepatogastrostomy, along with gaining access in complicated anatomy such as in patients with Rou-en-Y anatomy. Another useful endoscopic tool is nonsurgical drainage of the gallbladder, which can be a suitable option when patients are not optimal surgical candidates. There has also been an increase in outpatient utilization of ERCP, which was previously seen as a predominantly inpatient procedure in the past. Possible future evolutions of biliary interventions include robotic manipulation of a duodenoscope and direct infusion of chemotherapeutic or immunomodulatory agents into the pancreaticobiliary tree. These advancements will depend on parallel advancements in other imaging and laboratory as well as breakthrough technology or techniques by other disciplines including interventional radiology and minimally invasive surgery.
Publikationsverlauf
Artikel online veröffentlicht:
10. August 2021
© 2021. Thieme. All rights reserved.
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References
- 1 Rabinov KR, Simon M. Peroral cannulation of the ampulla of Vater for direct cholangiography and pancreatography. Preliminary report of a new method. Radiology 1965; 85 (04) 693-697
- 2 McCune WS, Shorb PE, Moscovitz H. Endoscopic cannulation of the ampulla of Vater: a preliminary report. Ann Surg 1968; 167 (05) 752-756
- 3 Kozarek RA. The past, present, and future of endoscopic retrograde cholangiopancreatography. Gastroenterol Hepatol (N Y) 2017; 13 (10) 620-622
- 4 Mazen Jamal M, Yoon EJ, Saadi A, Sy TY, Hashemzadeh M. Trends in the utilization of endoscopic retrograde cholangiopancreatography (ERCP) in the United States. Am J Gastroenterol 2007; 102 (05) 966-975
- 5 Kapoor BS, Mauri G, Lorenz JM. Management of biliary strictures: state-of-the-art review. Radiology 2018; 289 (03) 590-603
- 6 Campos S, Silva N, Carvalho A. A new paradigm in gallstones diseases and marked elevation of transaminases: an observational study. Ann Hepatol 2017; 16 (02) 285-290
- 7 Singh A, Gelrud A, Agarwal B. Biliary strictures: diagnostic considerations and approach. Gastroenterol Rep (Oxf) 2015; 3 (01) 22-31
- 8 Dorrell R, Pawa S, Pawa R. Endoscopic management of malignant biliary stricture. Diagnostics (Basel) 2020; 10 (06) E390
- 9 Lee JH, Salem R, Aslanian H, Chacho M, Topazian M. Endoscopic ultrasound and fine-needle aspiration of unexplained bile duct strictures. Am J Gastroenterol 2004; 99 (06) 1069-1073
- 10 Tummala P, Munigala S, Eloubeidi MA, Agarwal B. Patients with obstructive jaundice and biliary stricture ± mass lesion on imaging: prevalence of malignancy and potential role of EUS-FNA. J Clin Gastroenterol 2013; 47 (06) 532-537
- 11 Rerknimitr R, Angsuwatcharakon P, Ratanachu-ek T. et al; Asia-Pacific Working Group on Hepatobiliary Cancers. Asia-Pacific consensus recommendations for endoscopic and interventional management of hilar cholangiocarcinoma. J Gastroenterol Hepatol 2013; 28 (04) 593-607
- 12 De Moura DTH, Moura EGH, Bernardo WM. et al. Endoscopic retrograde cholangiopancreatography versus endoscopic ultrasound for tissue diagnosis of malignant biliary stricture: systematic review and meta-analysis. Endosc Ultrasound 2018; 7 (01) 10-19
- 13 van der Gaag NA, Rauws EA, van Eijck CH. et al. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med 2010; 362 (02) 129-137
- 14 De Lima SLA, Bustamante FAC, De Moura EGH. et al. Endoscopic palliative treatment versus surgical bypass in malignant low bile duct obstruction: a systematic review and meta-analysis. Int J Hepatobiliary Pancreat Dis 2015; 5: 35
- 15 Kaassis M, Boyer J, Dumas R. et al. Plastic or metal stents for malignant stricture of the common bile duct? Results of a randomized prospective study. Gastrointest Endosc 2003; 57 (02) 178-182
- 16 Sawas T, Al Halabi S, Parsi MA, Vargo JJ. Self-expandable metal stents versus plastic stents for malignant biliary obstruction: a meta-analysis. Gastrointest Endosc 2015; 82 (02) 256-267.e7
- 17 England RE, Martin DF, Morris J. et al. A prospective randomised multicentre trial comparing 10 Fr Teflon Tannenbaum stents with 10 Fr polyethylene Cotton-Leung stents in patients with malignant common duct strictures. Gut 2000; 46 (03) 395-400
- 18 Libby ED, Leung JW. Ultrasmooth plastic to prevent stent clogging. Gastrointest Endosc 1994; 40 (03) 386-387
- 19 Sung JY, Shaffer EA, Costerton JW. Antibacterial activity of bile salts against common biliary pathogens. Effects of hydrophobicity of the molecule and in the presence of phospholipids. Dig Dis Sci 1993; 38 (11) 2104-2112
- 20 Ghosh S, Palmer KR. Prevention of biliary stent occlusion using cyclical antibiotics and ursodeoxycholic acid. Gut 1994; 35 (12) 1757-1759
- 21 Irving JD, Adam A, Dick R, Dondelinger RF, Lunderquist A, Roche A. Gianturco expandable metallic biliary stents: results of a European clinical trial. Radiology 1989; 172 (02) 321-326
- 22 Isayama H, Komatsu Y, Tsujino T. et al. A prospective randomised study of “covered” versus “uncovered” diamond stents for the management of distal malignant biliary obstruction. Gut 2004; 53 (05) 729-734
- 23 Zorrón Pu L, de Moura EG, Bernardo WM. et al. Endoscopic stenting for inoperable malignant biliary obstruction: a systematic review and meta-analysis. World J Gastroenterol 2015; 21 (47) 13374-13385
- 24 Ahmed O, Lee JH. Modern gastrointestinal endoscopic techniques for biliary tract cancers. Linchuang Zhongliuxue Zazhi 2020; 9 (01) 3
- 25 Coelen RJS, Roos E, Wiggers JK. et al. Endoscopic versus percutaneous biliary drainage in patients with resectable perihilar cholangiocarcinoma: a multicentre, randomised controlled trial. Lancet Gastroenterol Hepatol 2018; 3 (10) 681-690
- 26 Hameed A, Pang T, Chiou J. et al. Percutaneous vs. endoscopic pre-operative biliary drainage in hilar cholangiocarcinoma - a systematic review and meta-analysis. HPB (Oxford) 2016; 18 (05) 400-410
- 27 Smith AC, Dowsett JF, Russell RC, Hatfield AR, Cotton PB. Randomised trial of endoscopic stenting versus surgical bypass in malignant low bile duct obstruction. Lancet 1994; 344 (8938): 1655-1660
- 28 Vienne A, Hobeika E, Gouya H. et al. Prediction of drainage effectiveness during endoscopic stenting of malignant hilar strictures: the role of liver volume assessment. Gastrointest Endosc 2010; 72 (04) 728-735
- 29 Hong W, Sun X, Zhu Q. Endoscopic stenting for malignant hilar biliary obstruction: should it be metal or plastic and unilateral or bilateral?. Eur J Gastroenterol Hepatol 2013; 25 (09) 1105-1112
- 30 Lee TH, Kim TH, Moon JH. et al. Bilateral versus unilateral placement of metal stents for inoperable high-grade malignant hilar biliary strictures: a multicenter, prospective, randomized study (with video). Gastrointest Endosc 2017; 86 (05) 817-827
- 31 Lee TH, Moon JH, Choi JH. et al. Prospective comparison of endoscopic bilateral stent-in-stent versus stent-by-stent deployment for inoperable advanced malignant hilar biliary stricture. Gastrointest Endosc 2019; 90 (02) 222-230
- 32 Alvarez-Sánchez MV, Napoléon B. Review of endoscopic radiofrequency in biliopancreatic tumours with emphasis on clinical benefits, controversies and safety. World J Gastroenterol 2016; 22 (37) 8257-8270
- 33 Patel J, Rizk N, Kahaleh M. Role of photodynamic therapy and intraductal radiofrequency ablation in cholangiocarcinoma. Best Pract Res Clin Gastroenterol 2015; 29 (02) 309-318
- 34 Steel AW, Postgate AJ, Khorsandi S. et al. Endoscopically applied radiofrequency ablation appears to be safe in the treatment of malignant biliary obstruction. Gastrointest Endosc 2011; 73 (01) 149-153
- 35 Auriemma F, De Luca L, Bianchetti M, Repici A, Mangiavillano B. Radiofrequency and malignant biliary strictures: an update. World J Gastrointest Endosc 2019; 11 (02) 95-102
- 36 Pozsár J, Tarpay Á, Burai J. et al. Intraductal radiofrequency ablation can restore patency of occluded biliary self-expanding metal stents. Z Gastroenterol 2011; 49: A70
- 37 Kadayifci A, Atar M, Forcione DG, Casey BW, Kelsey PB, Brugge WR. Radiofrequency ablation for the management of occluded biliary metal stents. Endoscopy 2016; 48 (12) 1096-1101
- 38 Rustagi T, Jamidar PA. Intraductal radiofrequency ablation for management of malignant biliary obstruction. Dig Dis Sci 2014; 59 (11) 2635-2641
- 39 Yang J, Wang J, Zhou H. et al. Efficacy and safety of endoscopic radiofrequency ablation for unresectable extrahepatic cholangiocarcinoma: a randomized trial. Endoscopy 2018; 50 (08) 751-760
- 40 Coté GA, Mullady DK, Jonnalagadda SS. et al. Use of a pancreatic duct stent or guidewire facilitates bile duct access with low rates of precut sphincterotomy: a randomized clinical trial. Dig Dis Sci 2012; 57 (12) 3271-3278
- 41 Elmunzer BJ, Scheiman JM, Lehman GA. et al; U.S. Cooperative for Outcomes Research in Endoscopy (USCORE). A randomized trial of rectal indomethacin to prevent post-ERCP pancreatitis. N Engl J Med 2012; 366 (15) 1414-1422
- 42 Itoi T, Yamao K. EUS 2008 Working Group. EUS 2008 Working Group document: evaluation of EUS-guided choledochoduodenostomy (with video). Gastrointest Endosc 2009; 69 (2, Suppl): S8-S12
- 43 Savides TJ, Varadarajulu S, Palazzo L. EUS 2008 Working Group. EUS 2008 Working Group document: evaluation of EUS-guided hepaticogastrostomy. Gastrointest Endosc 2009; 69 (2, Suppl): S3-S7
- 44 Artifon EL, Safatle-Ribeiro AV, Ferreira FC. et al. EUS-guided antegrade transhepatic placement of a self-expandable metal stent in hepatico-jejunal anastomosis. JOP 2011; 12 (06) 610-613
- 45 Nguyen-Tang T, Binmoeller KF, Sanchez-Yague A, Shah JN. Endoscopic ultrasound (EUS)-guided transhepatic anterograde self-expandable metal stent (SEMS) placement across malignant biliary obstruction. Endoscopy 2010; 42 (03) 232-236
- 46 Giovannini M, Moutardier V, Pesenti C, Bories E, Lelong B, Delpero JR. Endoscopic ultrasound-guided bilioduodenal anastomosis: a new technique for biliary drainage. Endoscopy 2001; 33 (10) 898-900
- 47 Khashab MA, Levy MJ, Itoi T, Artifon EL. EUS-guided biliary drainage. Gastrointest Endosc 2015; 82 (06) 993-1001
- 48 Dhir V, Bhandari S, Bapat M, Joshi N, Vivekanandarajah S, Maydeo A. Comparison of transhepatic and extrahepatic routes for EUS-guided rendezvous procedure for distal CBD obstruction. United European Gastroenterol J 2013; 1 (02) 103-108
- 49 He J, Ahuja N, Makary MA. et al. 2564 resected periampullary adenocarcinomas at a single institution: trends over three decades. HPB (Oxford) 2014; 16 (01) 83-90
- 50 Nguyen NT, Masoomi H, Magno CP, Nguyen XM, Laugenour K, Lane J. Trends in use of bariatric surgery, 2003-2008. J Am Coll Surg 2011; 213 (02) 261-266
- 51 Wittgrove AC, Clark GW, Schubert KR. Laparoscopic gastric bypass, Roux-en-Y: technique and results in 75 patients with 3-30 months follow-up. Obes Surg 1996; 6 (06) 500-504
- 52 Borao FJ, Thomas TA, Steichen FM. Alternative operative techniques in laparoscopic Roux-en-Y gastric bypass for morbid obesity. JSLS 2001; 5 (02) 123-129
- 53 Peters M, Papasavas PK, Caushaj PF, Kania RJ, Gagné DJ. Laparoscopic transgastric endoscopic retrograde cholangiopancreatography for benign common bile duct stricture after Roux-en-Y gastric bypass. Surg Endosc 2002; 16 (07) 1106
- 54 Ceppa FA, Gagné DJ, Papasavas PK, Caushaj PF. Laparoscopic transgastric endoscopy after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2007; 3 (01) 21-24
- 55 Schreiner MA, Chang L, Gluck M. et al. Laparoscopy-assisted versus balloon enteroscopy-assisted ERCP in bariatric post-Roux-en-Y gastric bypass patients. Gastrointest Endosc 2012; 75 (04) 748-756
- 56 Bukhari M, Kowalski T, Nieto J. et al. An international, multicenter, comparative trial of EUS-guided gastrogastrostomy-assisted ERCP versus enteroscopy-assisted ERCP in patients with Roux-en-Y gastric bypass anatomy. Gastrointest Endosc 2018; 88 (03) 486-494
- 57 Runge TM, Chiang AL, Kowalski TE. et al. Endoscopic ultrasound-directed transgastric ERCP (EDGE): a retrospective multicenter study. Endoscopy 2020; ;(Sep) DOI: 10.1055/a-1254-3942.
- 58 Baron TH, Grimm IS, Swanstrom LL. Interventional approaches to gallbladder disease. N Engl J Med 2015; 373 (04) 357-365
- 59 Kjaer DW, Kruse A, Funch-Jensen P. Endoscopic gallbladder drainage of patients with acute cholecystitis. Endoscopy 2007; 39 (04) 304-308
- 60 Nam K, Kim DU, Lee TH. et al. Patient perception and preference of EUS-guided drainage over percutaneous drainage when endoscopic transpapillary biliary drainage fails: an international multicenter survey. Endosc Ultrasound 2018; 7 (01) 48-55
- 61 McCarthy ST, Tujios S, Fontana RJ. et al. Endoscopic transpapillary gallbladder stent placement is safe and effective in high-risk patients without cirrhosis. Dig Dis Sci 2015; 60 (08) 2516-2522
- 62 Tujios SR, Rahnama-Moghadam S, Elmunzer JB. et al. Transpapillary gallbladder stents can stabilize or improve decompensated cirrhosis in patients awaiting liver transplantation. J Clin Gastroenterol 2015; 49 (09) 771-777
- 63 Itoi T, Sofuni A, Itokawa F. et al. Endoscopic transpapillary gallbladder drainage in patients with acute cholecystitis in whom percutaneous transhepatic approach is contraindicated or anatomically impossible (with video). Gastrointest Endosc 2008; 68 (03) 455-460
- 64 Mutignani M, Iacopini F, Perri V. et al. Endoscopic gallbladder drainage for acute cholecystitis: technical and clinical results. Endoscopy 2009; 41 (06) 539-546
- 65 Baron TH, Topazian MD. Endoscopic transduodenal drainage of the gallbladder: implications for endoluminal treatment of gallbladder disease. Gastrointest Endosc 2007; 65 (04) 735-737
- 66 James TW, Baron TH. EUS-guided gallbladder drainage: a review of current practices and procedures. Endosc Ultrasound 2019; 8 (Suppl. 01) S28-S34
- 67 Peñas-Herrero I, de la Serna-Higuera C, Perez-Miranda M. Endoscopic ultrasound-guided gallbladder drainage for the management of acute cholecystitis (with video). J Hepatobiliary Pancreat Sci 2015; 22 (01) 35-43
- 68 Jang JW, Lee SS, Song TJ. et al. Endoscopic ultrasound-guided transmural and percutaneous transhepatic gallbladder drainage are comparable for acute cholecystitis. Gastroenterology 2012; 142 (04) 805-811
- 69 Oh D, Song TJ, Cho DH. et al. EUS-guided cholecystostomy versus endoscopic transpapillary cholecystostomy for acute cholecystitis in high-risk surgical patients. Gastrointest Endosc 2019; 89 (02) 289-298
- 70 Burhenne HJ, Stoller JL. Minicholecystostomy and radiologic stone extraction in high-risk cholelithiasis patients. Preliminary experience. Am J Surg 1985; 149 (05) 632-635
- 71 Hatzidakis AA, Prassopoulos P, Petinarakis I. et al. Acute cholecystitis in high-risk patients: percutaneous cholecystostomy vs conservative treatment. Eur Radiol 2002; 12 (07) 1778-1784
- 72 Kozarek RA. The future of ERCP. Endosc Int Open 2017; 5 (04) E272-E274