Okuno Nozomi, Hara Kazuo, Mizuno Nobumasa, Haba Shin, Kuwahara Takamichi, Kuraishi Yasuhiro, Tajika Masahiro, Tanaka Tsutomu, Onishi Sachiyo, Yamada Keisaku, Fumihara Daiki, Yanaidani Takafumi, Ishikawa Sho, Yamada Masanori, Yasuda Tsukasa, Elshair Moaz
Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.
Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan.
Endosc Ultrasound. 2022 Jul-Aug;11(4):319-324. doi: 10.4103/EUS-D-21-00154.
EUS-guided hepaticogastrostomy (EUS-HGS) is in widespread use; however, there are few dedicated devices. The B2 route is technically easier than the B3 route for guidewire insertion, dilation, and stenting but if performed with conventional oblique-viewing (OV) EUS, B2 puncture can cause transesophageal puncture and severe adverse events. The aim of this study was to assess the efficacy of forward-viewing (FV) EUS, which we have developed to improve safety for B2 puncture in EUS-HGS (B2-EUS-HGS).
This single-center retrospective study included 61 consecutive patients who underwent B2-EUS-HGS with FV between February 2020 and March 2021 at Aichi Cancer Center, Japan. The patients were prospectively enrolled, and clinical data were retrospectively collected for these 61 cases.
The overall technical success rate of EUS-HGS was 98.3% (60/61). The rate of EUS-HGS with FV was 95.0% (58/61) after three cases converted to OV, and that of B2-EUS-HGS with FV was 88.5% (54/61). The early adverse event rate was 6.5% (4/61). There were no instances of transesophageal puncture. Median procedure time was 24 min (range, 8-70), and no patient required cautery dilation.
B2-EUS-HGS can be performed safely using FV, without transesophageal puncture, and supportability of the device is improved as FV is coaxial with the guidewire. FV was efficacious in B2-EUS-HGS, which shows promise for clinical application in the future.
超声内镜引导下肝胃吻合术（EUS-HGS）应用广泛，但专用设备较少。在导丝插入、扩张和支架置入方面，B2路径在技术上比B3路径更容易，然而，如果使用传统的斜视角（OV）超声内镜进行操作，B2穿刺可能导致经食管穿刺和严重不良事件。本研究的目的是评估我们开发的前视（FV）超声内镜在提高EUS-HGS（B2-EUS-HGS）中B2穿刺安全性方面的疗效。
这项单中心回顾性研究纳入了2020年2月至2021年3月在日本爱知癌症中心连续接受B2-EUS-HGS且使用FV的61例患者。患者为前瞻性纳入，对这61例病例的临床数据进行回顾性收集。
EUS-HGS的总体技术成功率为98.3%（60/61）。3例转为OV后，FV引导下的EUS-HGS成功率为95.0%（58/61），FV引导下的B2-EUS-HGS成功率为88.5%（54/61）。早期不良事件发生率为6.5%（4/61）。无经食管穿刺病例。中位手术时间为24分钟（范围8 - 70分钟），无患者需要烧灼扩张。
使用FV可安全进行B2-EUS-HGS，无经食管穿刺情况，且由于FV与导丝同轴，设备的可操作性得到改善。FV在B2-EUS-HGS中有效，显示出未来临床应用的前景。
