ERCP Topics

Abstract

IntroductionClinical investigations aimed at enhancing efficacy, improving safety, and expanding applications of endoscopic retrograde cho− langiopancreatography (ERCP) remain vital. The most compell− ing themes address new techniques and new technologies ap− plied to new and old problems. While the development of endo− scopic ultrasonography (EUS) and other imaging technologies has diminished the role of ERCP as a diagnostic tool, the growth in orthotopic liver transplantation and gastric bypass surgery have created new therapeutic applications and challenges. This review covers some of the highlights from this year's Digestive Disease Week. Biodegradable StentsBiodegradable stents hold the promise of achieving large−diame− ter stenting for a programmed period of time without the need for a repeat intervention for removal or revision. There are also prospects for impregnating the devices with antimicrobial, anti− inflammatory, and antineoplastic agents. These stents share per− formance characteristics with conventional self−expanding me− tallic stents. Theoretically, they can be bioengineered to dissolve at a designated time after implantation. Two papers were pres− ented that describe the applications of self−expanding biode− gradable stents in swine models of benign biliary stricture and cystic duct stump leak [1,2]. In these two small trials, the results with the biodegradable stents were equal to or better than those with self−expanding metallic stents and fixed−diameter plastic stents. While these data are promising, human clinical trials will be needed for definitive assessment. Covered SEMS for Palliation of Malignant Biliary ObstructionSelf−expanding metallic stents (SEMS) have compared favorably with fixed−diameter plastic stents (FDPS) for palliation of malig− nant biliary obstruction. SEMS allow a larger−diameter endo− prosthesis than is feasible with FDPS, and the larger diameter generally implies longer patency. However, SEMS become em− bedded into the biliary epithelium, preventing subsequent re− moval. Covered SEMS provide the size advantages of uncovered SEMS with the prospect of preventing tissue ingrowth through the interstices of the metal mesh, with an opportunity for re− moval if occlusion and/or a need for revision arise. Two abstracts [3,4] presented prospectively collected data on the performance of covered SEMS in the palliative treatment of malignant biliary obstruction. In the first, 95 patients with pancreatic cancer un− derwent placement of a 40−mm, 60−mm or 80−mm covered SEMS, regardless of resectability. Covered SEMS were deployed across the distal stricture and below the cystic duct in patients with an intact gallbladder. Staging was then carried out with computed tomography, magnetic resonance imaging, and/or EUS−guided fine−needle aspiration. Pancreaticoduodenectomy was carried out in 14 of the 19 patients deemed resectable. In all cases, the SEMS was easily removed without complications at the time of resection. The 81 unresected patients with covered SEMS had a mean survival o...

Ictericia obstructiva de causa maligna irresecable tras CPRE fallida: factores predictores del pronóstico: Tratamiento mediante drenaje guiado por ecoendoscopia versus drenaje percutáneo

“…prótesis biodegradables, el manejo de las complicaciones biliares de los pacientes trasplantados, la coledocolitiasis tras cirugía por obesidad mórbida o el tratamiento endoscópico de las colecciones pancreáticas(47).…”