Elshair Moaz, Hara Kazuo, Okuno Nozomi, Haba Shin, Kuwahara Takamichi, Bakr Asmaa, Elshafei Abdou, Abu-Amer Mohamed Z
Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.
Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Clin Endosc. 2024 Jul;57(4):542-546. doi: 10.5946/ce.2022.209. Epub 2023 May 3.
Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) through ducts B2 or B3 is effective in most patients with biliary obstruction, because B2 and B3 commonly join together. However, in some patients, B2 and B3 do not join each other due to invasive hilar tumors; therefore, single-route drainage is insufficient. Here, we investigated the feasibility and efficacy of EUS-HGS through both B2 and B3 simultaneously in seven patients. We decided to perform EUS-HGS through both B2 and B3 to achieve adequate biliary drainage because these two ducts were separate from each other. Here, we report a 100% technical and overall clinical success rate. Early adverse effects were closely monitored. Minimal bleeding was reported in one patient (1/7) and mild peritonitis in one patient (1/7). None of the patients experienced stent dysfunction, fever, or bile leakage after the procedure. EUS-HGS through both B2 and B3 simultaneously is safe, feasible, and effective for biliary drainage in patients with separated ducts.
经内镜超声引导下通过B2或B3胆管进行肝胃吻合术（EUS-HGS）对大多数胆道梗阻患者有效，因为B2和B3通常会合在一起。然而，在一些患者中，由于肝门部肿瘤侵犯，B2和B3并不相连；因此，单路径引流是不够的。在此，我们研究了在7例患者中同时通过B2和B3进行EUS-HGS的可行性和有效性。由于这两条胆管彼此分离，我们决定同时通过B2和B3进行EUS-HGS以实现充分的胆道引流。在此，我们报告技术成功率和总体临床成功率均为100%。对早期不良反应进行了密切监测。1例患者（1/7）出现轻微出血，1例患者（1/7）出现轻度腹膜炎。术后无患者出现支架功能障碍、发热或胆汁漏。对于胆管分离的患者，同时通过B2和B3进行EUS-HGS用于胆道引流是安全、可行且有效的。
