Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.
Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam, AGEM Institute, Amsterdam, The Netherlands.
Endoscopy. 2022 Feb;54(2):185-205. doi: 10.1055/a-1717-1391. Epub 2021 Dec 22.
1: ESGE recommends the use of endoscopic ultrasound-guided biliary drainage (EUS-BD) over percutaneous transhepatic biliary drainage (PTBD) after failed endoscopic retrograde cholangiopancreatography (ERCP) in malignant distal biliary obstruction when local expertise is available.Strong recommendation, moderate quality evidence. 2: ESGE suggests EUS-BD with hepaticogastrostomy only for malignant inoperable hilar biliary obstruction with a dilated left hepatic duct when inadequately drained by ERCP and/or PTBD in high volume expert centers.Weak recommendation, moderate quality evidence. 3: ESGE recommends that EUS-guided pancreatic duct (PD) drainage should only be considered in symptomatic patients with an obstructed PD when retrograde endoscopic intervention fails or is not possible.Strong recommendation, low quality evidence. 4: ESGE recommends rendezvous EUS techniques over transmural PD drainage in patients with favorable anatomy owing to its lower rate of adverse events.Strong recommendation, low quality evidence. 5: ESGE recommends that, in patients at high surgical risk, EUS-guided gallbladder drainage (GBD) should be favored over percutaneous gallbladder drainage where both techniques are available, owing to the lower rates of adverse events and need for re-interventions in EUS-GBD.Strong recommendation, high quality of evidence. 6: ESGE recommends EUS-guided gastroenterostomy (EUS-GE), in an expert setting, for malignant gastric outlet obstruction, as an alternative to enteral stenting or surgery.Strong recommendation, low quality evidence. 7: ESGE recommends that EUS-GE may be considered in the management of afferent loop syndrome, especially in the setting of malignancy or in poor surgical candidates. Strong recommendation, low quality evidence. 8: ESGE suggests that endoscopic ultrasound-directed transgastric ERCP (EDGE) can be offered, in expert centers, to patients with a Roux-en-Y gastric bypass following multidisciplinary decision-making, with the aim of overcoming the invasiveness of laparoscopy-assisted ERCP and the limitations of enteroscopy-assisted ERCP.Weak recommendation, low quality evidence.
1：当局部专业知识可用时，对于恶性远端胆道梗阻在 ERCP 失败后，ESGE 建议使用内镜超声引导下胆道引流（EUS-BD）而非经皮经肝胆道引流（PTBD）。强烈推荐，中等质量证据。 2：ESGE 建议对于不可切除的高位胆门部恶性梗阻性病变，当 ERCP 和/或 PTBD 引流不充分时，仅在大容量专家中心行 EUS-BD 肝胃吻合术。弱推荐，中等质量证据。 3：ESGE 建议对于因逆行内镜干预失败或不可行而导致阻塞性胰管（PD）的有症状患者，仅考虑行 EUS 引导下 PD 引流。强烈推荐，低质量证据。 4：ESGE 建议在解剖结构有利的患者中，由于其不良事件发生率较低，采用经皮经胃汇合 EUS 技术优于经壁 PD 引流。强烈推荐，低质量证据。 5：ESGE 建议在具有高手术风险的患者中，当两种技术都可使用时，应优先选择 EUS 引导下胆囊引流（GBD）而非经皮胆囊引流，因为 EUS-GBD 的不良事件发生率和再干预率较低。强烈推荐，高质量证据。 6：ESGE 建议在专家环境中，对于恶性胃出口梗阻，采用 EUS 引导下胃肠吻合术（EUS-GE）作为肠内支架或手术的替代方法。强烈推荐，低质量证据。 7：ESGE 建议对于吸收不良综合征，尤其是在恶性肿瘤或手术候选条件差的情况下，可考虑采用 EUS-GE 治疗。强烈推荐，低质量证据。 8：ESGE 建议在多学科决策后，内镜超声引导下经胃逆行胰胆管造影术（EDGE）可在专家中心提供给 Roux-en-Y 胃旁路术后的患者，目的是克服腹腔镜辅助 ERCP 的侵袭性和经内镜逆行胰胆管造影术的局限性。弱推荐，低质量证据。
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