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Drainage biliaire endoscopique dans les sténoses malignes de la convergence hilaire

Endoscopic biliary drainage in malignant stenosis of the liver hilum

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Résumé

Du fait des progrès de l’imagerie par résonance magnétique, la CPRE a surtout un intérêt thérapeutique pour le drainage biliaire palliatif des stades non résécables de cholangiocarcinomes hilaires. Par rapport à la voie percutanée, elle représente une alternative moins invasive; les prothèses métalliques auto expansibles sont préférables aux prothèses plastique dès lors que la non résécabilité est établie. Sauf dans les stades I et dans les stades très évolués, le drainage complet, ou tout au moins bilatéral par deux prothèses, semble réduire le risque angiocholitique iatrogène et même prolonger la survie. Sa réalisation par voie endoscopique repose sur des artifices techniques dont on rappelle les grands principes.

Summary

Due to the progress of magnetic resonance imaging, ERCP is mainly of therapeutic interest for palliative biliary drainage of the nonresectable stages of hilar cholangiocarcinoma. Compared to the percutaneous route, it represents a less invasive alternative; selfexpanding metal stents are preferable to plastic stents when it has been established that the lesion cannot be surgically removed. With the exception of stage I and the very advanced stages, complete drainage, or at least bilateral drainage with two prostheses, seems to reduce the risk of iatrogenic angiocholitis and even to prolong survival. Its realization via endoscopy relies on technical modalities, the underlying principles of which will be discussed here.

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Author information

Correspondence to R. Dumas.

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Dumas, R., Ezzedine, S. Drainage biliaire endoscopique dans les sténoses malignes de la convergence hilaire. Acta Endosc 36, 127–134 (2006). https://doi.org/10.1007/BF03006406

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Mots-clés

  • cholangiocarcinomes hilaires
  • CPRE
  • prothèses biliaires

Key-words

  • biliary stents
  • ERCP
  • Klatskin tumors