Mazza Stefano, Masciangelo Graziella, Mauro Aurelio, Scalvini Davide, Torello Viera Francesca, Bardone Marco, Veronese Letizia, Rovedatti Laura, Agazzi Simona, Strada Elena, Pozzi Lodovica, Barteselli Chiara, Sgarlata Carmelo, Ravetta Valentina, Fusaroli Pietro, Anderloni Andrea
Gastroenterology and Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy.
Gastroenterology Unit, Hospital of Imola, University of Bologna, 40026 Imola, Italy.
Diagnostics (Basel). 2024 Nov 24;14(23):2644. doi: 10.3390/diagnostics14232644.
Endoscopic ultrasound-guided biliary drainage (EUS-BD) has dramatically spread and improved in the last two decades and is changing the paradigm of drainage in case of malignant biliary obstruction (MBO). EUS-BD can be achieved from different routes, including the common bile duct (choledochoduodenostomy), intrahepatic bile ducts (hepaticogastrostomy), and gallbladder as a rescue (cholecystogastrostomy/cholecystoduodenostomy). EUS-guided hepaticogastrostomy (EUS-HGS) is a valuable option for biliary drainage in MBO when ERCP fails or is not feasible. EUS-HGS has demonstrated high efficacy with a good rate of technical and clinical success. The safety profile is also overall favorable, although severe adverse events may occur in a significant proportion of patients. From a technical perspective, EUS-HGS is considered one of the most demanding procedures in biliopancreatic endoscopy, requiring multiple steps and high technical skills and experience. In this comprehensive review, technical tips and clinical outcomes of EUS-HGS are reviewed according to the latest evidence in the literature.
在过去二十年中，内镜超声引导下胆道引流（EUS-BD）已得到显著推广并不断改进，正在改变恶性胆道梗阻（MBO）时的引流模式。EUS-BD可通过不同途径实现，包括胆总管（胆总管十二指肠吻合术）、肝内胆管（肝胃吻合术）以及作为补救措施的胆囊（胆囊胃吻合术/胆囊十二指肠吻合术）。当内镜逆行胰胆管造影（ERCP）失败或不可行时，超声内镜引导下肝胃吻合术（EUS-HGS）是MBO胆道引流的一种有价值的选择。EUS-HGS已显示出高疗效，技术成功率和临床成功率良好。尽管相当比例的患者可能会发生严重不良事件，但总体安全性也较好。从技术角度来看，EUS-HGS被认为是胆胰内镜检查中要求最高的操作之一，需要多个步骤以及高超的技术技能和经验。在这篇综述中，我们根据文献中的最新证据，对EUS-HGS的技术要点和临床结果进行了综述。
