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Gastroenterologie up2date 2024; 20(01): 69-87
DOI: 10.1055/a-2025-3529
Wichtige Methoden in der Gastroenterologie

Transbulbäre und transgastrale Gallengangsdrainage

Indikation, Durchführung, Komplikationen
Philipp Thies
,
Markus Dollhopf
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Die endoskopisch retrograde Cholangiopankreatikografie (ERCP) ist der Goldstandard für die Drainage der obstruktiven Cholestase maligner und benigner Erkrankungen, mit einer geringen Misserfolgsrate von 4–16% [1]. Bei fehlgeschlagener ERCP stehen verschiedene endosonografisch geführte Rescue-Verfahren (EUS-BD) zur Verfügung, deren Indikation und Durchführung im Folgenden vorgestellt werden.
Kernaussagen

  • EUS-geführte biliäre Drainagen (EUS-BD) stellen eine Gruppe von „Rescue-Verfahren“ nach fehlgeschlagener ERCP dar.

  • Sie ermöglichen einen direkten Zugang zu den Gallengängen vom Magen oder vom Duodenum aus, ohne dass die Papille zwingend erreicht werden muss.

  • Transduodenal lassen sich der extrahepatische Ductus (hepato-)choledochus und transgastral intrahepatische Gallengänge im linken Leberlappen punktieren.

  • Die Drainagenplatzierung am Zielort erfolgt entweder in Seldinger-Technik (prinzipiell für alle Verfahren realisierbar) oder als Direktpunktionsverfahren bei der EUS-gesteuerten Choledochoduodenostomie und Gallenblasendrainage.

  • Die optimale Drainagestrategie richtet sich nach dem Ort der Obstruktion (distal/hilär) und der zugrunde liegenden Erkrankung (benigne/maligne).

  • Es handelt sich um komplexe Verfahren, bei denen das Ergebnis maßgeblich durch die Fähigkeiten und Erfahrung des Untersuchers und der Expertise des Teams des gesamten Zentrums determiniert wird.

  • Technische und klinische Erfolgsraten von 90% und darüber sind nach Datenlage erreichbar und stellen die Zielvorgabe dar.

  • Je nach Verfahren ist mit Komplikationen in ca. 5–18% der Fälle zu rechnen. Diese sind in der Regel konservativ oder endoskopisch beherrschbar.

Schlüsselwörter

endoskopisch retrograd - Cholangiopankreatikografie - endoskopischer Ultraschall - biliäre Drainage - EUS-geführt


Publikationsverlauf

Artikel online veröffentlicht:
20. März 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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