Technical tips for endoscopic ultrasound-guided hepaticogastrostomy

作     者：Takeshi Ogura Kazuhide Higuchi 

作者机构：Second Department of Internal Medicine Osaka Medical College 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2016年第22卷第15期

页      面：3945-3951页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：Endoscopic ultrasound Endoscopic ultrasound-guided hepaticogastrostomy Endoscopic ultrasound-guided biliary drainage Endoscopic retrograde cholangiopancreatography 

摘      要：Interventional procedures using endoscopic ultrasound(EUS) have recently been developed. For biliary drainage, EUS-guided trans-luminal drainage has been reported. In this procedure, the transduodenal approach for extrahepatic bile ducts is called EUSguided choledochoduodenostomy, and the transgastric approach for intrahepatic bile ducts is called EUSguided hepaticogastrostomy(EUS-HGS). These procedures have several effects, such as internal drainage and avoiding post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis, and they are indicated for an inaccessible ampulla of Vater due to duodenal obstruction or surgical anatomy. EUS-HGS has particularly wide indications and clinical impact as an alternative biliary drainage method. In this procedure, it is necessary to dilate the fistula, and several devices and approaches have been reported. Stent selection is also important. In previous reports, the overall technical success rate was 82%(221/270), the clinical success rate was 97%(218/225), and the overall adverse event rate for EUS-HGS was 23%(62/270). Adverse events of EUS-biliary drainage are still high compared with ERCP or PTCD. EUSHGS should continue to be performed by experienced endoscopists who can use various strategies when adverse events occur.