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01.09.2009 | Topics | Ausgabe 5/2009

Journal of Hepato-Biliary-Pancreatic Sciences 5/2009

Current topics in pancreato-biliary endotherapy: what can we do?

Zeitschrift:
Journal of Hepato-Biliary-Pancreatic Sciences > Ausgabe 5/2009
Autor:
Hiroyuki Isayama

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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