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Endoscopic retrograde cholangiopancreatography,lights and shadows:Handle with care

World Journal of Gastrointestinal Endoscopy 2019年第3期11卷 219-230页

作者： Raffaele Salerno Nicolò Mezzina Sandro Ardizzone Gastroenterology and Digestive Endoscopy Unit ASST Fatebenefratelli Sacco Gastrointestinal Unit ASST Fatebenefratelli Sacco-Department of Biochemical and Clinical Sciences "L. Sacco" University of Milan

The role of endoscopic retrograde cholangiopancreatography(ERCP) has dramatically changed in the last years, mainly into that of a therapeutic procedure. The treatment of benign biliary disease, like "difficult"choledocolithiasis, with endoscopic papillary large balloon dilation combined with endoscopic sphinterotomy has proven an effective and safe ***, safety in ERCP has improved as well, with the prevention of postERCP pancreatitis and patient-to-patient transmission of infections. The advent of self-expandable metal stenting has radically changed the management of biliopancreatic malignant strictures, while the role for therapy of benign strictures is still controversial. In addition, cholangioscopy(though the direct visualization of the biliopancreatic ductal system) has allowed for characterization of indeterminate biliary strictures and facilitated rescue therapy of large biliary stones deemed removable. Encouraging data from tissue ablation techniques, such as photodynamic therapy and radiofrequency ablation, need to be confirmed by large sample size clinical controlled trials. On the other hand, we have no drug-coated stents yet available to implant and evidence for the use of biodegradable stents is still weak. The competency and privileging of ERCP and endoscopic ultrasonography have been analyzed longer but the switch between the two procedures, at the same time, is becoming ordinary; as such, the endoscopist interested in this field should undergo parallel edification through training plans. Finally, the American Society for Gastrointestinal Endoscopy's statement on non-anesthesiologist administration of propofol for gastrointestinal endoscopy is not actually endorsed by the European Society of Anaesthesiology,having many medical-legal implications in some European countries.

关键词： Cholangiopancreatography Endoscopic papillary large balloon dilation Self-expandable metal stent Cholangioscopy Photodynamic therapy Radiofrequency ablation Competency privileging Biodegradable stents Drug-coated stents

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