Résumé
Les prothèses biliaires et pancréatiques sont utilisées dans de multiples indications au premier rang desquelles les sténoses biliaires bénignes ou malignes et les sténoses du Wirsung essentiellement dans le cadre des pancréatites chroniques. Les fistules biliaires et les volumineux calculs impossibles à extraire en une seule séance sont d’autres indications possibles. Les cancers du pancréas et de la voie biliaire principale sont une indication de stents métalliques. Cette indication est absolue en cas de situation palliative, mais la pose d’un stent métallique peut être licite en situation préopératoire sous certaines conditions. Les sténoses du hile posent des problèmes spécifiques. Les sténoses bénignes sont couramment traitées par des prothèses plastiques multiples. Des travaux récents suggèrent une efficacité équivalente des stents métalliques totalement couverts. Les sténoses du Wirsung dans le cadre d’une pancréatite chronique sont accessibles à un traitement par une ou plusieurs prothèses plastiques. Quelques travaux récents suggèrent une efficacité des stents métalliques totalement couverts dans cette indication qui reste à évaluer plus précisément. Lorsque la voie d’abord rétrograde n’est pas possible, l’abord transgastrique ou transbulbaire sous guidage échoendoscopique est une option dont la place par rapport à l’abord percutané reste à définir.
Abstract
Biliary and pancreatic stents are used in several indications. Among them, the most frequent are benign and malignant biliary strictures andWirsung stenosis, most often in patients with chronic pancreatitis. Biliary fistula and big stones are other possible indications. Self-expandable metal stents are indicated in pancreatic cancers and common bile duct cancers, without restrictions in palliative situations and under certain conditions in pre-operative situation. Benign biliary strictures are currently treated by multiple plastic stents. Recent studies however suggest that self-expandable metal stents could be suitable in these cases, with same results as plastic stents. Wirsung strictures in patients with chronic pancreatitis can be treated by one or several plastic stents. A few studies suggest an equivalent efficiency of full-covered self-expandable metal stents. When retrograde endoscopic approach is not possible, the option of an endoscopic ultrasonography guided drainage could be considered.
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Laugier, R., Védrenne, B. Prothèses biliaires et pancréatiques : indications, résultats et techniques. Acta Endosc 44, 312–318 (2014). https://doi.org/10.1007/s10190-014-0412-y
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DOI: https://doi.org/10.1007/s10190-014-0412-y
Mots clés
- Sténose biliaire
- Pancréatite chronique
- Cancer du pancréas
- Traitement endoscopique
- Stent bilaire
- Stent pancréatique
- Stent métallique auto-expansible