Abstract
Introduction
Endotherapy is progressing steadily, especially for various pancreato-biliary diseases. This article introduced new procedures and devices, and revealed improvement of treatment outcomes.
Materials and methods
Biliary covered metallic stent (CMS) has developed, and the indication of CMS placement is changing because of its removability. CMS is effective not only for unresectable biliary malignancies but also for resectable tumors, benign biliary strictures, and benign pancreatic strictures. Drug-eluting CMS can be used as anti-tumor agents. Interventional endoscopic ultrasonography (EUS) has shifted the treatment paradigm because it is possible to approach lesions through the digestive tract wall. The diagnosis and treatment of pancreatic cancer using interventional EUS technique are effective, feasible, and promising. Recently, trans-gastric necrosectomy for an infected pseudocyst was reported as an alternative treatment to surgery. Double- and single-balloon enteroscopy will be performed more frequently to treat the pancreato-biliary disorders in the patients with altered anatomy. Endoscopic papillary large balloon dilation (EPLBD), new procedure to the papilla, can treat large bile duct stones effectively without lithotripsy.
Conclusion
This paper introduces current developments in endotherapy to surgeons. These procedures are of very great interest because they alter the treatment algorithms for many pancreato-biliary diseases.
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References
Davids PHP, Groen AK, Rauws EAJ, Tytgat GN, Huibregtse K. Randomized trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet. 1992;340:1488–92.
Knyrim K, Wagner HJ, Pausch J, Vakil N. A prospective, randomized, controlled trial of metal stents for malignant obstruction of the common bile duct. Endoscopy. 1993;25:207–12.
Isayama H, Komatsu Y, Tsujino T, Yoshida H, Tada M, Shiratori Y, et al. Polyurethane-covered metal stent for management of distal malignant biliary obstruction. Gastrointest Endosc. 2002;55:366–70.
Nakai Y, Isayama H, Komatsu Y, Tsujino T, Toda N, Sasahira N, et al. Efficacy and safety of covered Wallstent in patients with distal malignant biliary obstruction. Gastrointest Endosc. 2005;62:742–8.
Kubota Y, Mukai H, Nakaizumi A, Tanaka K, Okabe Y, Sakagami T, et al. Covered Wallstent for palliation of malignant common bile duct stricture: prospective multicenter evaluation. Dig Endosc. 2005;17:218–23.
Isayama H, Komatsu Y, Tsujino T, Sasahira N, Hirano K, Toda N, et al. A prospective randomised study of “covered” versus “uncovered” diamond stents for the management of distal malignant biliary obstruction. Gut. 2004;53:729–34.
Kahaleh M, Tokar J, Le T, Yeaton P. Removal of self-expandable metallic Wallstents. Gastrointest Endosc. 2004;40:640–4.
Sanjeev M, Wasan SM, Ross WA, Lee JH. Use of expandable metallic biliary stents in resectable pancreatic cancer. Am J Gastroenterol. 2005;100:2056–61.
Suk KT, Kim JW, Kim HS, Baik SK, Oh SJ, Lee SJ, et al. Human application of a metallic stent covered with a paclitaxel-incorporated membrane for malignant biliary obstruction: multicenter pilot study. Gastrointest Endosc. 2007;66:798–803.
Vaira D, D’Anna L, Ainley C, Dowsett J, Williams S, Baillie J, et al. Endoscopic sphincterotomy in 1000 consecutive patients. Lancet. 1989;334:431–3.
Geenen JE, Toouli J, Hogan WJ, Dodds WJ, Stewart ET, Mavrelis P, et al. Endoscopic sphincterotomy; follow-up evaluation of effects on the sphincter of Oddi. Gastroenterology. 1984;87:754–8.
Komatsu Y, Kawabe T, Toda N, Ohashi M, Isayama H, Tateishi K, et al. Endoscopic papillary balloon dilation for the management of common bile duct stones: experience of 226 cases. Endoscopy. 1998;30:12–7.
Yasuda I, Tomita E, Enya M, Kato T, Moriwaki H. Can endoscopic papillary balloon dilation really preserve sphincter of Oddi function? Gut. 2001;49:686–91.
Isayama H, Komatsu Y, Inoue Y, Toda N, Shiratori Y, Tsujino T, et al. Preserved function of the Oddi sphincter after endoscopic papillary balloon dilation. Hepatogastroenterology. 2003;50:1787–91.
Fujita N, Maguchi H, Komatsu Y, Yasuda I, Hasebe O, Igarashi Y, et al. Endoscopic sphincterotomy and endoscopic papillary balloon dilatation for bile duct stones: a prospective randomized controlled multicenter trial. Gastrointest Endosc. 2003;57:151–5.
Tsujino T, Kawabe T, Komatsu Y, Yoshida, Isayama H, Sasaki T, et al. Endoscopic papillary balloon dilation for bile duct stone; immediate and long-term outcome in 1,000 patients. Clin Gastroenterol Hepatol. 2007;5:130–7.
Minami A, Okuyama T, Hirose S. Small sphincterotomy combined with papillary dilation with large balloon permits retrieval of large stones without crushing them. Gastrointest Endosc. 2004;59:AB200.
Itoi T, Itokawa F, Sofuni A, Kurihara T, Tsuchiya T, Ishii K, et al. Endoscopic sphincterotomy combined with large balloon dilation can reduce the procedure time and fluoroscopy time for removal of large bile duct stones. Am J Gastroenterol. 2009;104:560–5.
Maaser C, Lenze F, Bokemeyer M, Ullerich H, Domagk D, Bruewer M, et al. Double balloon enteroscopy: a useful tool for diagnostic and therapeutic procedures in the pancreaticobiliary system. Am J Gastroenterol. 2008;103:894–900.
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;33:898–900.
Chang KJ, Nguyen PT, Thompson JA, Kurosaki TT, Casey LR, Leung EC, et al. Phase I clinical trial of allogeneic mixed lymphocyte culture (cytoimplant) delivered by endoscopic ultrasound-guided fine-needle injection in patients with advanced pancreatic carcinoma. Cancer. 2000;88:1325–35.
Chang KJ, Lee JG, Holcombe RF, Kuo J, Muthusamy R, Wu ML. Endoscopic ultrasound delivery of an antitumor agent to treat a case of pancreatic cancer. Nat Clin Pract Gastroenterol Hepatol. 2008;5(2):107–11.
Kahaleh M, Hernandez AJ, Tokar J, Adams RB, Shami VM, Yeaton P. Interventional EUS-guided cholangiography: evaluation of a technique in evolution. Gastrointest Endosc. 2006;64:52–9.
Seifert H, Wehrmann T, Schmitt T, Zeuzem S, Caspary WF. Retroperitoneal endoscopic debridement for infected peripancreatic necrosis. Lancet. 2000;356(9230):653–5.
Seewald S, Groth S, Omar S, Imazu H, Seitz U, de Weerth A, et al. Aggressive endoscopic therapy for pancreatic necrosis and pancreatic abscess: a new safe and effective treatment algorithm. Gastrointest Endosc. 2005;62:92–100.
Voermans RP, Veldkamp MC, Rauws EA, Bruno MJ, Fockens P. Endoscopic transmural debridement of symptomatic organized pancreatic necrosis (with videos). Gastrointest Endosc. 2007;66:909–16.
Isayama H, Yamamoto K, Mizuno S, Yashima Y, Togawa O, Kogure H, et al. NOTES and endoscopic pancreatic necrosectomy for the GI endoscopist. J Hepatobiliary Pancreat Surg. 2009;16:270–3.
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Isayama, H. Current topics in pancreato-biliary endotherapy: what can we do?. J Hepatobiliary Pancreat Surg 16, 589–591 (2009). https://doi.org/10.1007/s00534-009-0136-0
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DOI: https://doi.org/10.1007/s00534-009-0136-0