Endoskopisches Management postoperativer Gallengangskomplikationen

Zusammenfassung

Die Endoskopisch-retrograde Cholangio-Pankreatikografie (ERCP) ist die Methode der ersten Wahl bei postoperativen Komplikationen an den Gallenwegen. Sie treten meist als Leckagen nach Cholezystektomien und Leberteilresektionen auf. Nach Lebertransplantation sind Gallelecks, Stenosen sowie Gangobstruktionen die häufigsten Komplikationen, die mit signifikanter Morbidität und Mortalität sowie der Gefahr des Transplantatversagens einhergehen. Die Chance zur langfristig erfolgreichen Therapie einer Gallengangskomplikation mittels ERCP hängt von 3 Faktoren ab: (i) Art, Lokalisation und Umfang der Schädigung, (ii) Zeitpunkt des Auftretens nach der Operation und (iii) der konsequenten Durchführung der endoskopischen Therapie. Bei veränderter Anatomie, wie sie eine Hepatiko- oder Choledocho-Jejunostomie darstellten, kann die endoskopische Therapie in vielen Fällen via Enteroskopie erfolgen.

Abstract

Endoscopic-retrograde cholangiopancreaticography (ERCP) is the method of choice for the treatment of surgical complications of the biliary system. Biliary leaks most frequently occur after cholecystectomy and partial liver resection. The most frequent complications after liver transplantation include biliary leaks, strictures and obstructive cholestasis. They are associated with significant morbidity and mortality as well as the risk of failure of the transplanted organ. The chance for a long-term successful therapy via ERCP is dependent on three main factors: (i) type, localisation and extent of the biliary damage, (ii) the time-point of appearance after surgery and (iii) the consequent accomplishment of the endoscopic therapy. In case of altered anatomy, e. g., hepatico- or choledocho-jejunostomy, endoscopic therapy can often be accomplished via an enteroscopic approach.

Schlüsselwörter

ERCP - endoskopisch-retrograde Cholangio-Pankreatikografie - Stenose - Obstruktion - Gallengangs-Leckage - Stent

Key words

ERCP - endoscopic-retrograde cholangiopancreaticography - stenosis - obstruction - biliary leaks - stents

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