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Therapeutic interventional endoscopic ultrasound in pancreatobiliary disorders:Does it really replace the surgical/percutaneous approach?

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World Journal of Gastrointestinal Surgery 2021年第6期13卷 537-547页

作者： Cosmas Rinaldi Adithya Lesmana Maria Satya Paramitha Rino Alvani Gani Department of Internal Medicine Hepatobiliary DivisionDr.Cipto Mangunkusumo National General HospitalMedical Faculty Universitas IndonesiaJakarta 10430Indonesia Digestive Disease and GI Oncology Center Medistra HospitalJakarta 12950Indonesia

pancreato-biliary disorders are still incredibly challenging in the field of gastroenterology,as they would sometimes require multi-approach interventional ***,therapeutic interventional endoscopic ultrasound(EUS)has emerged as a potential alternative to surgical or percutaneous ***,considering the high cost of EUS,lack of facility and expertise,most gastroenterologists still often refer cases to undergo surgical interventions without contemplating the possibility of utilizing EUS ***-guided biliary drainage has become one of the best choices for establishing access to biliary system,given the clear visualization of pancreas,gallbladder,and common bile *** there are still only a few studies which directly compare EUSguided and surgical approaches for biliary drainage,current evidence demonstrated the superiority of EUS-guided approach in terms of adverse events and reintervention rates,with similarly high technical and clinical success rates compared to percutaneous and surgical approaches,especially in patients with history of failed endoscopic retrograde cholangiopancreatography *** success rates with shorter length of hospital stay between endoscopic and surgical approaches have also been exhibited for pancreatic pseudocysts and walled-off *** findings about the progress of EUS approach in gastroenterostomy/jejunostomy also indicated a promising potential of EUS,as a less invasive approach,for managing gastric outlet obstruction.

关键词： pancreato-biliary Endoscopic ultrasound Percutaneous approach Surgical approach biliary drainage Pancreatic fluid collection

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Biomarkers in bile-complementing advanced endoscopic imaging in the diagnosis of indeterminate biliary strictures

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World Journal of Gastrointestinal Endoscopy 2015年第4期7卷 308-317页

作者： Vennisvasanth Lourdusamy Benjamin Tharian Udayakumar Navaneethan Center for Interventional Endoscopy Institute for Minimally Invasive SurgeryFlorida Hospital

biliary strictures present a diagnostic challenge and a conundrum, particularly when an initial work up including abdominal imaging and endoscopic retrograde cholangiopancreatography based sampling are nondiagnostic. Advances in endoscopic imaging have helped us diagnose these strictures better. However, even with modern technology, some strictures remain a diagnostic challenge. The proximity of bile fluid to the bile duct epithelia makes it an attractive option to investigate for bio-markers, which might be representative of the functions/abnormal changes taking place in the biliary system. A number of biomarkers in bile have been discovered recently in approaching biliary strictures with their potential future diagnostic utility, further supported by the immunohistochemical analysis of the resected tissue specimens. Novel biliary biomarkers especially carcinoembryonic cell adhesion molecule 6 and neutrophil gelatinase-associated lipocalin seem promising in differentiating malignant from benign biliary strictures. Recent developments in lipidomic profiling of bile are also very promising. biliary biomarkers appear to complement endoscopic imaging in diagnosing malignant etiologies of biliary stricture. Future studies addressing these biomarkers need to be incorporated to the current endoscopic techniques to determine the best approach in determining the etiology of biliary strictures.

关键词： Bile pancreato-biliary malignancies Biomarkers Cholangiocarcinoma Pancreatic cancers biliary strictures

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