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Главная Статьи Эндоскопическое лечение камней общего желчного протока: руководство Европейского общества желудочно-кишечной эндоскопии (ESGE)

Статьи: Эндоскопическое лечение камней общего желчного протока: руководство Европейского общества желудочно-кишечной эндоскопии (ESGE)

35 мин
Авторы: Gianpiero Manes 1 Gregorios Paspatis 2 Lars Aabakken 2019г.
Об авторах: 1. Azienda Ospedaliera "Guido Salvini", Garbagnate Milanese · Department of Gastroenterology and Endoscopy
2. General Hospital of Heraklion Venizeleio and Pananio

Аннотация:

Эндоскопическое лечение камней общего желчного протока: руководство Европейского общества желудочно-кишечной эндоскопии (ESGE) и обновление руководства Sociedade Portuguesa de Endoscopia Digestiva (SPED) 2019


Основные рекомендации
ESGE рекомендует предлагать удаление камней всем пациентам с общими камнями желчных протоков, симптоматическими или нет, которые достаточно приспособлены, чтобы переносить вмешательство.
Сильная рекомендация, доказательства низкого качества.

ESGE рекомендует тесты функции печени и УЗИ брюшной полости в качестве начальных диагностических шагов при подозрении на камни общего желчного протока. Сочетание этих тестов определяет вероятность наличия общих камней желчных протоков.
Сильная рекомендация, умеренное качество доказательств.

ESGE рекомендует проводить эндоскопическую ультрасонографию или магнитно-резонансную холангиопанкреатографию для диагностики камней общего желчного протока у пациентов с постоянным клиническим подозрением, но недостаточными данными о камнях на УЗИ брюшной полости.
Сильная рекомендация, умеренное качество доказательств.

ESGE рекомендует следующие сроки для желчного дренажа, предпочтительно эндоскопического, у пациентов с острым холангитом, классифицированные в соответствии с пересмотром Токийских руководящих принципов 2018 года:
- тяжелые, как можно скорее и в течение 12 часов для пациентов с септическим шоком
- умеренные, в течение 48 - 72 часа
- мягкий, факультативный.
Сильная рекомендация, доказательства низкого качества.

ESGE рекомендует эндоскопическое размещение временного желчного пластикового стента у пациентов с безвозвратными желчными камнями, которые требуют дренирования желчных путей.
Сильная рекомендация, умеренное качество доказательств.

ESGE рекомендует ограниченную сфинктеротомию в сочетании с эндоскопической папиллярной дилатацией большого баллона в качестве первой линии для удаления сложных камней общего желчного протока.
Сильная рекомендация, высокое качество доказательств.

ESGE рекомендует использовать внутрипросветную литотрипсию с помощью холангиоскопии (электрогидравлическую или лазерную) в качестве эффективного и безопасного лечения сложных камней желчных протоков.
Сильная рекомендация, умеренное качество доказательств.

ESGE рекомендует проводить лапароскопическую холецистэктомию в течение 2 недель после ERCP для пациентов, лечившихся от холедохолитиаза, чтобы снизить уровень конверсии и риск рецидивов желчных протоков.
Сильная рекомендация, умеренное качество доказательств.

Эндоскопическое лечение камней общего желчного протока: руководство Европейского общества желудочно-кишечной эндоскопии (ESGE)

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Главное в публикации: 

  • Четко указаны алгоритмы и тактика при холедохолитиазе на современном уровне
  • Дана рекомендация разрешать холедохолитиаз тотально всем

Вывод:

DOI: 10.1055/a-0862-0346 Endoscopy 2019; 51(05): 472-491 © Georg Thieme Verlag KG Stuttgart· New York

Список литературы:

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