Ultrasonografia endoskopowa (EUS) w diagnostyce i leczeniu kamicy przewodów dróg żółciowych. Współczesna rola ECPW

• Authors: Jacek Kiełtucki

Title variants

EN

Endoscopic Ultrasonography (EUS) in Diagnostics and Treatment of Bile Duct Stones. The Current Role of ERCP

• Languages of publication: PL EN

Abstracts

PL

Precyzyjna diagnostyka obecności kamicy żółciowej przewodowej, przeprowadzona możliwie najmniej inwazyjnymi metodami, jest ważna przy podejmowaniu decyzji terapeutycznych. Nie tylko proste badania (jak konwencjonalna ultrasonografia – USG), ale też bardziej wyszukane metody obrazowania (tomografia komputerowa, rezonans magnetyczny) są często zawodne. Złotym standardem nieinwazyjnej diagnostyki kamicy przewodowej jest cholangiografia rezonansu magnetycznego – cholangio MRI. Rola cholangiopankreatografii wstecznej – ECPW w diagnostyce nieco przesunęła się na dalszy plan, ze względu na możliwość licznych istotnych powikłań. Pomimo pewnych wad, takich jak potencjalnie zwiększony koszt leczenia, konieczność wykonywania zabiegu przez lekarza doświadczonego zarówno w endoskopowej cholangiopankreatografii, jak i endoskopowej ultrasonografii, najbardziej efektywnym schematem postępowania diagnostyczno-terapeutycznego w przypadku podejrzenia kamicy przewodowej jest wykonanie diagnostycznej endoskopowej ultrasonografii z następową, jednoczasową endoskopową cholangiopankreatografią celem usunięcia złogów. Zastosowanie endoskopowej ultrasonografii pozwala ograniczyć liczbę wykonywanych endoskopowych cholangiopankreatografii o ponad 2/3. Endoskopowa cholangiopankreatografia wsteczna połączona z endoskopowym nacięciem zwieracza brodawki Vatera i mechaniczną ewakuacją złogów z przewodu nadal pozostaje złotym standardem w leczeniu kamicy przewodowej.

EN

Precise evaluation of the presence of bile duct stones, performed using the most non-invasive method, is important for the planning of optimal treatment. Not only simple imaging procedures (like conventional transabdominal ultrasound – US) but also more sophisticated imaging methods (CT or MRI) are frequently unreliable. The optimal method of bile duct stone non-invasive diagnostics is magnetic resonance cholangiography. The role of endoscopic retrograde cholangiopancreatography in diagnostics has receded into the background due to the possibility of numerous serious complications. Despite some limitations such as potentially increased treatment costs as well as the necessity of the procedure to be performed by a surgeon experienced in both endoscopic retrograde cholangiopancreatography as well as endoscopic ultrasonography, diagnostic endoscopic ultrasonography followed by simultaneous endoscopic retrograde cholangiopancreatography aimed at gallstone removal is the most efficient diagnostic and therapeutic management scheme in cases of suspected choledocholithiasis. The use of endoscopic ultrasonography allows one to limit the number of performed endoscopic retrograde cholangiopancreatography procedures by more than 2/3. Ascending endoscopic retrograde cholangiopancreatography combined with an endoscopic incision into the ampulla of Vater followed by mechanical evacuation of stone deposits from the ducts still remains a the optimal procedure in the treatment of choledocholithiasis.

Keywords

EN

biliary stent; choledocholithiasis; diagnostics; diagnostyka; endoscopic ultrasonography; kamica żółciowa przewodowa; proteza żółciowa; ultrasonografia endoskopowa

Discipline

• MEDICINE: MEDICINE

• Publisher: Śląski Uniwersytet Medyczny w Katowicach
• Journal: Annales Academiae Medicae Silesiensis
• Year: 2017
• Volume: 71
• Pages: 326-330

Contributors

author

Jacek Kiełtucki

• Oddział Chorób Wewnętrznych, Pracownia Endoskopii, Samodzielny Publiczny Zespół Zakładów Opieki Zdrowotnej w Staszowie

References

• 1. Tazuma S. Gallstone disease: Epidemiology, pathogenesis, and classification of biliary stones (common bile duct and intrahepatic). Best Prac. Res. Clin. Gastroenterol. 2006; 20(6): 1075–1083.
• 2. Freitas M.L., Bell R.L., Duffy A.J. Choledocholithiasis: Evolving standards for diagnosis and management. World J. Gastroenterol. 2006; 12(20): 3162–3167.
• 3. Caddy G., Tham T. Gallstone disease: Symptoms, diagnosis and endo-scopic management of common bile duct stones. Best Prac. Res. Clin. Gastro-enterol. 2006; 20(6): 1085–1101.
• 4. Dimagno E.P., Regan P.T., Clain J.E., James E.M., Buxton J.L. Human endoscopic ultrasonography. Gastroenterology 1982; 83(4): 824–829.
• 5. Butani M.S. Endoscopic ultrasonography. Endoscopy; 2002; 34(11): 888–895.
• 6. Hajnal J.V., Hill D..LG., Hawkes D.J. Medical image registration. CRC Press. Boca Raton 2001.
• 7. Konturek S.J. Gastroenterologia i hepatologia kliniczna. Wydawnictwo Lekarskie PZWL. Warszawa 2002, s. 462–506.
• 8. Amouyal P., Amouyal G., Levy P., Tuzet S., Palazzo L., Vilgrain V., Gayet B., Belghiti J., Fékété F., Bernades P. Diagnosis of choledocholithiasis by endoscopic ultrasonography. Gastroenterology. 1994; 106(4): 1062–1067.
• 9. Canto M., Chak A., Sivak M.V. Jr, Blades E., Stellato T. Endoscopic ultrasonography versus cholangiography for diagnosis of extrahepatic biliary stones: a prospective blinded study in pre- and post-choiecystectomy patients. Gastrointest. Endosc. 1995; 41: A384.
• 10. Cotton P.B. Non-operative removal of bile ducts stones by duodenoscopic sphincterotomy. Br. J. Surg. 1980; 67(1): 1–5.
• 11. Edmundowicz S., Aliperti G., Middleton W. Preliminary experience using endoscopic ultrasonography in the diagnosis of choledocholithiasis. Endoscopy. 1992; 24(9): 774–778.
• 12. Polkowski M., Regula J., Tilszer A., Butruk E. Endoscopic ultrasound versus endoscopic retrograde cholangiography for patients with intermediate probability of bile duct stones: a randomized trial comparing two manage-ment strategies. Endoscopy. 2007; 39: 296–303.
• 13. Yasuda I., Tomita E., Moriwaki H., Kato T., Wakahara T., Sugihara J., Nagura K., Nishigaki Y., Sugiyama A., Enya M. Endoscopic papillary ballon dilatation for common bile duct stones: efficacy of combination with extracorporeal Shockwave lithotripsy for large stones. Eur. J. Gastroenterol. Hepatol. 1998; 10: 1045–1050.
• 14. Kawai K.Y., Akasaka Y., Murakami K., Tada M., Koli Y. Endoscopic sphincterotomy of the ampulla of Vater. Gastrointest. Endosc. 1974; 20(4): 148–150.
• 15. Soehendra N., Reynders-Frederix V. Palliative Gallengangdrainage. Dtsch Med. Wschr. 1979; 104(6): 206–207.
• 16. Davids P.H.P., Groen A.K., Rauws E.A., Tytgat G.N., Huibregtse K. Randomized trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet 1992; 340(8834–8835): 1488–1492.
• 17. Soehendra N., Reynders-Frederix V. Palliative bile duct drainage: a new endoscopic method of introducing a transpapillary drain. Endoscopy. 1980; 12(1): 8–11.
• 18. Arhan M., Ödemis B., Parlak E., Ertuğrul I., Başar O. Migration of biliary plastic stents: experience of a tertiary center. Surg Endosc. 2009; 23(4): 769–775.
• 19. Anderson E.M., Phillips-Hughes J., Chapman R. Sigmoid colonic perforation and pelvic abscess complicating biliary stent migration. Abdom Imaging. 2007; 32(3): 317–319.
• 20. Petrov M.S., van Santvoort H.C., Besselink M.G., van der Heijden G.J., van Erpecum K.J., Gooszen H.G. Early endoscopic retrograde cholangiopan-creatography versus conservative management in acute biliary pancreatitis without cholangitis: a meta-analysis of randomized trials. Ann Surg. 2008; 247(2): 250–257.
• 21. Loperfido S., Angelini G., Benedetti G., Chilovi F., Costan F., De Be-rardinis F., De Bernardin M., Ederle A., Fina P., Fratton A. Major early complications from diagnostic and therapeutic ERCP: a prospective, multi-center study. Gastrointest Endosc. 1998; 48(1): 1–10.
• 22. Masci E., Toti G., Mariani A., Curioni S., Lomazzi A., Dinelli M., Minoli G., Crosta C., Comin U., Fertitta A., Prada A., Passoni G.R., Testoni P.A. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am. J. Gastroenterol. 2001: 96; 417–423.
• 23. Williams E.J., Green J., Beckingham I., Parks R., Martin D., Lombard M. Guidelines on the management of common bile duct stones (CBDS). Gut. 2008; 57(7): 1004–1021.
• 24. Frey C.F., Burbige E.J., Meinke W.B., Pullos T.G., Wong H.N., Hickman D.M., Belber J. Endoscopic retrograde cholangiopancreatography. Am. J. Surg. 1982; 144(1): 109–114.
• 25. Barkun J.S., Fried G.M., Barkun A.N., Sigman H.H., Hinchey E.J., Garzon J., Wexler M.J., Meakins J.L. Cholecystectomy without operative cholangiography. Implications for common bile duct injury and retained common bile duct stones. Ann. Surg. 1993; 218(3): 371–317.
• 26. Baron T.H., Irani S. Prevention of post-ERCP pancreatitis. Minerva Med. 2014; 105(2): 129–136.
• 27. Tse F., Liu L., Barkun A.N., Armstrong D., Moayyedi P. EUS: a meta-
• -analysis of test performance in suspected choledocholithiasis. Gastrointest Endoscopy. 2008; 67(2): 235–244.
• 28. Aube C., Delorme B., Yzet T., Burtin P., Lebigot J., Pessaux P., Gondry-Jouet C., Boyer J., Caron C. MR cholangiopancreatography versus endo-scopic sonography in suspected common bile duct lithiasis: a prospective, comparative study. AJR Am. J. Roentgenol. 2005; 184(1): 55–62.
• 29. Kawakubo K., Kawakami H., Kuwatani M., Haba S., Kudo T., Abe Y., Kawahata S., Onodera M., Ehira N., Yamato H., Eto K., Sakamoto N. Safety and utility of single-session endosopic ultrasonography and endoscopic retrograde cholangiopancreatography for the evaluation of pancreatobiliary disease. Gut Liver. 2014; 8(3): 329–332.
• 30. Petrov M.S., Savides T.J. Systematic review of endoscopic ultrasonography versus endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis. Br. J. Surg. 2009; 96(9): 967–974.
• 31. Collins C., Maguire D., Ireland A., Fitzgerald E., O'Sullivan G.C. A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy: natural history of choledocholithiasis revisited. Ann. Surg. 2004; 239(1): 28–33.

• Document Type: article