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Endoskopie heute 2003; 16(4): 176-182
DOI: 10.1055/s-2003-819983
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© Georg Thieme Verlag Stuttgart · New York

Endoskopische Papillotomie (EPT) - eine selektive Literaturrecherche der beiden letzten Jahre

Endoscopic Papillotomy (EPT) - A Selective Literature Research for the Last Two YearsM. Classen1 , P. Born1
  • 1II. Medizinische Klinik und Poliklinik, Klinikum r. d. Isar, Technische Universität München
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Publication History

Publication Date:
19 February 2004 (online)

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Zusammenfassung

Fundamentale Veränderungen am Papillotom und an der Inzisionstechnik haben seit der Einführung der Methode im Jahr 1973 nicht stattgefunden. Die Einführung eines Führungsdrahtes hat jedoch die Anwendung des Papillotoms signifikant verbessert. Auch wurde der selektive Zugang zum Gallengang und zum Pankreasgang durch eine Modifikation der Schneidetechnik erleichtert. Wenn der selektive Zugang zum gestauten Gallengang zunächst nicht möglich erscheint, der Pankreasgang jedoch sondiert werden kann, dann kann eine Inzision vom Ductus Wirsungianus durch das Gewebe der Papille bis in den Gallengang durchgeführt werden, ohne dass die Komplikationsrate bei diesem Vorgehen ansteigt. Das Nadelmesser ist hilfreich, wenn eine enge Öffnung die selektive Einführung des Erlanger Papillotoms in einen der Gänge nicht gestattet. Dies gelingt besonders leicht und risikoarm, wenn die Papille vergrößert ist. Für eine Vielzahl von Erkrankungen von Papilla major et minor, für Veränderungen des Gallen- und des Pankreasgangssystems stellt die endoskopische Papillotomie eine maßgeschneiderte und minimalinvasive Therapie dar. Einige Fragen sind zum gegenwärtigen Zeitpunkt nicht definitiv und für alle Patienten zu beantworten, nämlich die Rolle der EPT bei akuter biliärer Pankreatitis und bei Sphinkter Oddi Dyskinesie des Pankreassphinkters. Die Einführung eines dünnkalibrigen Stents in den Pankreasgang nach EPT bei Risikopatienten verhindert die am meisten gefürchtete Komplikation, nä mlich die akute biliäre Pankreatitis bei vielen, aber nicht bei allen Patienten. Für diese und andere offene Fragestellungen werden weitere klinische Studien benötigt.

Abstract

Following the introduction of endoscopic papillotomy (EPT) in 1973 there have not been any substantial modifications neither of the papillotome itself nor of the cutting technique. Using the papillotome over a guidewire has greatly facilitated the procedure. The guidewire also enables better selective cannulation of the common bile duct; should this fail and the pancreatic duct be intubated, papillotomy in an upwards direction via the pancreatic orifice until the biliary duct is reached has been shown to be successful without an increase in complication rate. In case of failure of even pancreatic duct cannulation, the needle knife is used to gain access to the pancreatobiliary system, a successful and easy way especially in enlarged papillas. Endoscopic papillotomy has established itself as a tailored and minimal-invasive treatment modality for a variety of diseases of both papillae, as well as of the biliary tract and the pancreatic duct. Still, some questions remain unanswered even at present, e. g. the role of sphincterotomy in acute biliary pancreatitis and spincter Oddi dyskinesia of the pancreatic sphincter. Placement of a small-caliber stent into the pancreatic duct after papillotomy in patients at high risk of pancreatitis - the most feared complication of ERCP and papillotomy - has been shown to reduce this complication. Further studies are needed to clarify this and other open question.

Schlüsselwörter

Endoskopische Papillotomie - Sphinkterotomie - Pankreopathien, Erkrankungen des biliären Systems

Key words

Endoscopic papillotomy - Sphincterectomy - pancreatic/hiliary disorders

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Prof. Dr. Drs. h. c. M. Classen

II. Medizinische Klinik und Poliklinik · Klinikum r. d. Isar · Technische Universität München

Ismaninger Str. 22

81675 München

Phone: 0 89/41 40-22 57

Fax: 0 89/41 40-67 05

Email: meinhard.classen@lrz.tum.de

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