Current topics in pancreato-biliary endotherapy: what can we do?
BACKGROUND
Endotherapy is progressing steadily, especially for various pancreato-biliary diseases. This article introduced new procedures and devices, and revealed improvement of treatment outcomes.


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.


CONCLUSIONS
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.
Isayama
Hiroyuki
H
Department of Gastroenterology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. isayama-tky@umin.ac.jp
D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D002404:Catheterization / Q000379:methods; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods / Q000639:trends; D016145:Endoscopy, Digestive System / Q000379:methods* / Q000639:trends; D019160:Endosonography / Q000379:methods / Q000639:trends; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D010182:Pancreatic Diseases / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D018570:Risk Assessment; D015607:Stents; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional