エビデンスよりみた閉塞性黄疸（中下部胆管閉塞）における術前胆道ドレナージ
下部胆管閉塞に対する術前胆道ドレナージの意義については欧米と我国や癌の発生部位などで意見が異なる．前向き臨床試験，メタ解析，ガイドラインなどを検討した．下部胆管閉塞に対する術前胆道ドレナージは胆管炎などがなければ，ルーチンには術前胆道ドレナージを必要としないとの意見もみられる．膵頭部癌に関しては術前補助療法を行う施設が増えている．そのため，術前胆道ドレナージの必要性の有無よりも，ドレナージ法（ERCPかPTBD），ドレナージの材質（self-expandable metallic stentかplastic stent）の前向き臨床試験が必要となる．一方，中下部胆管癌に対しては術前補助療法の考...
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| Published in | Tando Vol. 31; no. 2; pp. 228 - 236 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本胆道学会
2017
Japan Biliary Association |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0914-0077 1883-6879 |
| DOI | 10.11210/tando.31.228 |
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| Abstract | 下部胆管閉塞に対する術前胆道ドレナージの意義については欧米と我国や癌の発生部位などで意見が異なる．前向き臨床試験，メタ解析，ガイドラインなどを検討した．下部胆管閉塞に対する術前胆道ドレナージは胆管炎などがなければ，ルーチンには術前胆道ドレナージを必要としないとの意見もみられる．膵頭部癌に関しては術前補助療法を行う施設が増えている．そのため，術前胆道ドレナージの必要性の有無よりも，ドレナージ法（ERCPかPTBD），ドレナージの材質（self-expandable metallic stentかplastic stent）の前向き臨床試験が必要となる．一方，中下部胆管癌に対しては術前補助療法の考えは少なく，術前胆道ドレナージ先行か手術先行やドレナージ法やドレナージの材質の問題の解決が必要となる．我が国の術前胆道ドレナージの臨床試験は少なく，今後，目的と対象を絞って前向き臨床試験で検討していく必要がある． |
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| AbstractList | 下部胆管閉塞に対する術前胆道ドレナージの意義については欧米と我国や癌の発生部位などで意見が異なる．前向き臨床試験，メタ解析，ガイドラインなどを検討した．下部胆管閉塞に対する術前胆道ドレナージは胆管炎などがなければ，ルーチンには術前胆道ドレナージを必要としないとの意見もみられる．膵頭部癌に関しては術前補助療法を行う施設が増えている．そのため，術前胆道ドレナージの必要性の有無よりも，ドレナージ法（ERCPかPTBD），ドレナージの材質（self-expandable metallic stentかplastic stent）の前向き臨床試験が必要となる．一方，中下部胆管癌に対しては術前補助療法の考えは少なく，術前胆道ドレナージ先行か手術先行やドレナージ法やドレナージの材質の問題の解決が必要となる．我が国の術前胆道ドレナージの臨床試験は少なく，今後，目的と対象を絞って前向き臨床試験で検討していく必要がある． Preoperative biliary drainage (PBD) for obstructive jaundice by low bile duct obstruction was reviewed concerning randomized prospective control studies, meta-analyses and clinical practice guidelines in Japan, Europe and the United States. Preoperative biliary drainage is not routinely necessary in patients with obstructive jaundice in the middle or lower bile duct. PBD should be done in obstructive jaundice with cholangitis. Self-expandable metallic stent seems to be rather useful than plastic stent. In pancreatic head cancer, preoperative adjuvant therapy is frequently done and PBD is performed before preoperative adjuvant therapy. Thus, stenting method and stenting apparatus are the targets of examination hereafter. In distal bile duct cancer, preoperative adjuvant therapy is not usually done. Thus, the presence or absence of PBD, stenting method, and stenting equipment are the questions of further examination including prospective study. Most evidences concerning PBD come from foreign countries. Evidences from Japan is expected carefully considering the clinical practices. 下部胆管閉塞に対する術前胆道ドレナージの意義については欧米と我国や癌の発生部位などで意見が異なる．前向き臨床試験，メタ解析，ガイドラインなどを検討した．下部胆管閉塞に対する術前胆道ドレナージは胆管炎などがなければ，ルーチンには術前胆道ドレナージを必要としないとの意見もみられる．膵頭部癌に関しては術前補助療法を行う施設が増えている．そのため，術前胆道ドレナージの必要性の有無よりも，ドレナージ法（ERCPかPTBD），ドレナージの材質（self-expandable metallic stentかplastic stent）の前向き臨床試験が必要となる．一方，中下部胆管癌に対しては術前補助療法の考えは少なく，術前胆道ドレナージ先行か手術先行やドレナージ法やドレナージの材質の問題の解決が必要となる．我が国の術前胆道ドレナージの臨床試験は少なく，今後，目的と対象を絞って前向き臨床試験で検討していく必要がある． |
| Author | 山口, 幸二 |
| Author_FL | Yamaguchi Koji |
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| Author_xml | – sequence: 1 fullname: 山口, 幸二 organization: 国家公務員共済組合連合会浜の町病院 福岡合同庁舎診療所 |
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| DocumentTitleAlternate | Preoperative biliary drainage in patients with obstructive jaundice by middle or distal bile duct obstruction from the viewpoints of evidences |
| DocumentTitle_FL | Preoperative biliary drainage in patients with obstructive jaundice by middle or distal bile duct obstruction from the viewpoints of evidences |
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| References | 19) Eshuis WJ, van der Gaag NA, Rauws EA, et al. Therapeutic delay and survival after surgery for cancer of the pancreatic head with or without preoperative biliary drainage. Ann Surg 2010; 252: 840-849 3) Hatfield AR, Tobias R, Terblanche J, et al. Preoperative external biliary drainage in obstructive jaundice. A prospective controlled clinical trial. Lancet 1982; 2: 896-899 7) Velanovich V, Kheibek T, Khan M. Relationship of postoperative complications from preoperative biliary stents after pancreaticoduodenectomy. A new cohort analysis and meta-analysis of modern studies. JOP 2009; 10: 24-29 27) Khorana AA, Mangu PB, Berlin J, et al. Potentially Curable Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2016; 34: 2541-2556 30) 日本膵臓学会. 膵癌取扱い規約. 第7版. 東京: 金原出版, 2016 24) NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Hepatobiliary Cancers Version 2. 2016 NCCN Clinical Practice guidelines in Oncology. [cited 2017 Jan 26] Available from https://www.nccn.org/professionals/physician_gls/PDF/hepatobiliary.pdf 5) Saleh MM, Norregaard P, Jorgensen HL, et al. Preoperative endoscopic stent placement before pancreaticoduodenectomy: A meta-analysis of the effect on morbidity and mortality. Gastrointest Endosc 2002; 56: 529-534 23) NCCN Clinical Practice guidelines in Oncology. Pancreatic adenocarcinma Version 2. 2016 [cited 2017 Jan 26] Available from https://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf 11) Fang Y, Gurusamy KS, Wang Q, et al. Meta-analysis of randomized clinical trials on safety and efficacy of biliary drainage before surgery for obstructive jaundice. Br J Surg 2013; 100: 1589-1596 17) Liu W, Fu XL, Yang JY, et al. Efficacy of Neo-Adjuvant Chemoradiotherapy for Resectable Pancreatic Adenocarcinoma: A PRISMA-compliant meta-analysis and systematic review. Medicine (Baltimore) 2016; 95: e3009 4) Sewnath ME, Karsten TM, Prins MH, et al. A meta-analysis on the efficacy of preoperative biliary drainage for tumors causing obstructive jaundice. Ann Surg 2002; 236: 17-27 18) van der Gaag NA, Rauws EA, van Eijck CH, et al. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med 2010; 362: 129-137 25) Ducreux M, Cuhna AS, Caramella C, et al. Cancer of the pancreas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015; 26 (Suppl 5): v56-68 1) Pitt HA, Gomes AS, Lois JF, et al. Does preoperative percutaneous biliary drainage reduce operative risk or increase hospital cost? Ann Surg 1985; 201: 545-553 9) Qiu YD, Bai JL, Xu FG, et al. Effect of preoperative biliary drainage on malignant obstructive jaundice: A meta-analysis. World J Gastroenterol 2011; 17: 391-396 29) 日本膵臓学会膵癌診療ガイドライン改訂委員会. 膵癌診療ガイドライン2016年版. 東京: 金原出版, 2016 26) Eckel F, Brunner T, Jelic S. Biliary cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2011; 22 (Suppl 6): vi40-44 14) Moole H, Bechtold M, Puli SR. Efficacy of preoperative biliary drainage in malignant obstructive jaundice: A meta-analysis and systematic review. World J Surg Oncol 2016; 14: 182 13) Chen Y, Ou G, Lian G, et al. Effect of Preoperative Biliary Drainage on Complications Following Pancreatoduodenectomy: A meta-analysis. Medicine (Baltimore) 2015; 94: e1199 10) Fang Y, Gurusamy KS, Wang Q, et al. Pre-operative biliary drainage for obstructive jaundice. Cochrane Database Syst Rev 2012; 9: CD005444 12) Sun C, Yan G, Li Z, et al. A meta-analysis of the effect of preoperative biliary stenting on patients with obstructive jaundice. Medicine (Baltimore) 2014; 93: e189 2) Takada T. Is preoperative biliary drainage necessary according to evidence-based medicine? J Hepatobiliary Pancreat Surg 2001; 8: 58-64 28) 日本肝胆膵外科学会. 胆道癌診療ガイドライン. 第2版. 東京: 医学図書出版, 2014 15) Crippa S, Cirocchi R, Partelli S, et al. Systematic review and meta-analysis of metal versus plastic stents for preoperative biliary drainage in resectable periampullary or pancreatic head tumors. Eur J Surg Oncol 2016; 42: 1278-1285 21) Guidelines for the management of patients with pancreatic cancer periampullary and ampullary carcinomas. Gut 2005; 54 (Suppl 5): v1-16 22) Khan SA, Davidson BR, Goldin RD, et al. Guidelines for the diagnosis and treatment of cholangiocarcinoma: an update. Gut 2012; 61: 1657-1669 6) Wang Q, Gurusamy KS, Lin H, et al. Preoperative biliary drainage for obstructive jaundice. Cochrane Database Syst Rev 2008; Cd005444 8) Garcea G, Chee W, Ong SL, et al. Preoperative biliary drainage for distal obstruction: the case against revisited. Pancreas 2010; 39: 119-126 16) Scheufele F, Schorn S, Demir IE, et al. Preoperative biliary stenting versus operation first in jaundiced patients due to malignant lesions in the pancreatic head: A meta-analysis of current literature. Surgery 2016 20) Song TJ, Lee JH, Lee SS, et al. Metal versus plastic stents for drainage of malignant biliary obstruction before primary surgical resection. Gastrointest Endosc 2016; 84: 814-821 |
| References_xml | – reference: 11) Fang Y, Gurusamy KS, Wang Q, et al. Meta-analysis of randomized clinical trials on safety and efficacy of biliary drainage before surgery for obstructive jaundice. Br J Surg 2013; 100: 1589-1596 – reference: 20) Song TJ, Lee JH, Lee SS, et al. Metal versus plastic stents for drainage of malignant biliary obstruction before primary surgical resection. Gastrointest Endosc 2016; 84: 814-821 – reference: 6) Wang Q, Gurusamy KS, Lin H, et al. Preoperative biliary drainage for obstructive jaundice. Cochrane Database Syst Rev 2008; Cd005444 – reference: 24) NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Hepatobiliary Cancers Version 2. 2016 NCCN Clinical Practice guidelines in Oncology. [cited 2017 Jan 26] Available from https://www.nccn.org/professionals/physician_gls/PDF/hepatobiliary.pdf – reference: 30) 日本膵臓学会. 膵癌取扱い規約. 第7版. 東京: 金原出版, 2016 – reference: 10) Fang Y, Gurusamy KS, Wang Q, et al. Pre-operative biliary drainage for obstructive jaundice. Cochrane Database Syst Rev 2012; 9: CD005444 – reference: 4) Sewnath ME, Karsten TM, Prins MH, et al. A meta-analysis on the efficacy of preoperative biliary drainage for tumors causing obstructive jaundice. Ann Surg 2002; 236: 17-27 – reference: 5) Saleh MM, Norregaard P, Jorgensen HL, et al. Preoperative endoscopic stent placement before pancreaticoduodenectomy: A meta-analysis of the effect on morbidity and mortality. Gastrointest Endosc 2002; 56: 529-534 – reference: 1) Pitt HA, Gomes AS, Lois JF, et al. Does preoperative percutaneous biliary drainage reduce operative risk or increase hospital cost? Ann Surg 1985; 201: 545-553 – reference: 13) Chen Y, Ou G, Lian G, et al. Effect of Preoperative Biliary Drainage on Complications Following Pancreatoduodenectomy: A meta-analysis. Medicine (Baltimore) 2015; 94: e1199 – reference: 23) NCCN Clinical Practice guidelines in Oncology. Pancreatic adenocarcinma Version 2. 2016 [cited 2017 Jan 26] Available from https://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf – reference: 9) Qiu YD, Bai JL, Xu FG, et al. Effect of preoperative biliary drainage on malignant obstructive jaundice: A meta-analysis. World J Gastroenterol 2011; 17: 391-396 – reference: 7) Velanovich V, Kheibek T, Khan M. Relationship of postoperative complications from preoperative biliary stents after pancreaticoduodenectomy. A new cohort analysis and meta-analysis of modern studies. JOP 2009; 10: 24-29 – reference: 16) Scheufele F, Schorn S, Demir IE, et al. Preoperative biliary stenting versus operation first in jaundiced patients due to malignant lesions in the pancreatic head: A meta-analysis of current literature. Surgery 2016 – reference: 12) Sun C, Yan G, Li Z, et al. A meta-analysis of the effect of preoperative biliary stenting on patients with obstructive jaundice. Medicine (Baltimore) 2014; 93: e189 – reference: 26) Eckel F, Brunner T, Jelic S. Biliary cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2011; 22 (Suppl 6): vi40-44 – reference: 3) Hatfield AR, Tobias R, Terblanche J, et al. Preoperative external biliary drainage in obstructive jaundice. A prospective controlled clinical trial. Lancet 1982; 2: 896-899 – reference: 15) Crippa S, Cirocchi R, Partelli S, et al. Systematic review and meta-analysis of metal versus plastic stents for preoperative biliary drainage in resectable periampullary or pancreatic head tumors. Eur J Surg Oncol 2016; 42: 1278-1285 – reference: 19) Eshuis WJ, van der Gaag NA, Rauws EA, et al. Therapeutic delay and survival after surgery for cancer of the pancreatic head with or without preoperative biliary drainage. Ann Surg 2010; 252: 840-849 – reference: 22) Khan SA, Davidson BR, Goldin RD, et al. Guidelines for the diagnosis and treatment of cholangiocarcinoma: an update. Gut 2012; 61: 1657-1669 – reference: 8) Garcea G, Chee W, Ong SL, et al. Preoperative biliary drainage for distal obstruction: the case against revisited. Pancreas 2010; 39: 119-126 – reference: 21) Guidelines for the management of patients with pancreatic cancer periampullary and ampullary carcinomas. Gut 2005; 54 (Suppl 5): v1-16 – reference: 25) Ducreux M, Cuhna AS, Caramella C, et al. Cancer of the pancreas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015; 26 (Suppl 5): v56-68 – reference: 27) Khorana AA, Mangu PB, Berlin J, et al. Potentially Curable Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2016; 34: 2541-2556 – reference: 17) Liu W, Fu XL, Yang JY, et al. Efficacy of Neo-Adjuvant Chemoradiotherapy for Resectable Pancreatic Adenocarcinoma: A PRISMA-compliant meta-analysis and systematic review. Medicine (Baltimore) 2016; 95: e3009 – reference: 29) 日本膵臓学会膵癌診療ガイドライン改訂委員会. 膵癌診療ガイドライン2016年版. 東京: 金原出版, 2016 – reference: 2) Takada T. Is preoperative biliary drainage necessary according to evidence-based medicine? J Hepatobiliary Pancreat Surg 2001; 8: 58-64 – reference: 28) 日本肝胆膵外科学会. 胆道癌診療ガイドライン. 第2版. 東京: 医学図書出版, 2014 – reference: 14) Moole H, Bechtold M, Puli SR. Efficacy of preoperative biliary drainage in malignant obstructive jaundice: A meta-analysis and systematic review. World J Surg Oncol 2016; 14: 182 – reference: 18) van der Gaag NA, Rauws EA, van Eijck CH, et al. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med 2010; 362: 129-137 |
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| SubjectTerms | distal bile duct obstruction obstructive jaundice preoperative biliary drainage 下部胆管閉塞 術前胆道ドレナージ 閉塞性黄疸 |
| Title | エビデンスよりみた閉塞性黄疸（中下部胆管閉塞）における術前胆道ドレナージ |
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