Endoskopisch-retrograde Cholangiopankreatografie (ERCP) bei Patienten mit operativ veränderter Anatomie des Gastrointestinaltrakts

Zusammenfassung

Die endoskopisch-retrograde Cholangiopankreatografie (ERCP) ist ein Eckpfeiler in der Therapie von Erkrankungen des Gallenwegs- oder Pankreasgangsystems. Bei einigen Patienten ist der endoskopische Zugangsweg allerdings aufgrund vorausgegangener operativer Eingriffe verändert. Ziel dieser Übersichtsarbeit ist die Darstellung des endoskopischen Vorgehens bei der Behandlung von Patienten mit operativ modifizierter Anatomie des Gastrointestinaltrakts. Es wird hierbei die verfügbare Evidenz vorgestellt und anhand von eigenen Fallbeispielen illustriert. Zusammenfassend ist festzustellen, dass bei der partiellen Duodenopankreatektomie und der Billroth-II-Operation eine Endoskopie der Gallenwege in den meisten Fällen mit dem Duodenoskop oder mit konventionellen Endoskopen mit Geradeausblickoptik gelingt. Durch die Entwicklung ballongestützter Enteroskope wird eine ERC auch bei Patienten mit langem Zugangsweg zum Gallenwegsystem – wie etwa bei Roux-Y-Rekonstruktion – in etwa zwei Drittel der Fälle möglich. Die Erweiterung des Zubehörs für diese langen Geräte ermöglicht darüber hinaus eine erfolgreiche therapeutische Intervention.

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is an essential element in treating disease of the bilio-pancreatic system. In some patients, access to the bile ducts is limited due to operatively altered anatomy. The aim of this review is to illustrate the endoscopic procedure in these patients. We present the available evidence and comment on our approach to ERCP in patients with surgical modification of anatomy. In conclusion, conventional side-viewing or forward-viewing endoscopes allow one to access the biliary system in most patients with Billroth-II or partial pancreaticoduodenectomy. By use of balloon enteroscopy, biliary intervention in spite of surgical reconstruction with a long limb – such as Roux-en-Y gastrojejunostomy or hepaticojejunostomy and gastric bypass for obesity – has become feasible in many cases. Adaption of accessory devices to balloon-assisted enteroscopes permits therapeutic interventions in these patients.

Schlüsselwörter

endoskopisch-retrograde Cholangiopankreatografie (ERCP) - Billroth - Whipple - ballongestützte Enteroskope - Doppel-Ballon-Enteroskopie - Cholangitis

Key words

endoscopic retrograde cholangiopancreatography (ERCP) - Billroth - Whipple - balloon-assisted enteroscopy - double balloon enteroscopy - cholangitis

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