Ishiwatari Hirotoshi, Sakamoto Hiroki, Doi Takuya, Yamamura Masahiro
Division of Endoscopy Shizuoka Cancer Center Shizuoka Japan.
DEN Open. 2025 May 22;6(1):e70145. doi: 10.1002/deo2.70145. eCollection 2026 Apr.
Endoscopic ultrasound-guided biliary drainage (EUS-BD) is used when biliary drainage using endoscopic retrograde cholangiopancreatography fails. Recently, it has been adopted as a primary biliary drainage method, and its indications have expanded. Since EUS-BD can cause adverse events (AEs), such as bile leakage and stent migration, which do not occur in endoscopic retrograde cholangiopancreatography, endoscopists need to be well-versed in its management and preventive techniques. EUS-BD includes several procedures, such as EUS-guided choledochoduodenostomy (EUS-CDS), EUS-guided hepaticogastrostomy (EUS-HGS), EUS-guided antegrade stenting (EUS-AS), and EUS-guided rendezvous (EUS-RV). A recent meta-analysis reported that the overall AE rate of EUS-BD was 13.7% (EUS-CDS, 11.9%; EUS-HGS, 15.5%; EUS-AS, 9.9%; and EUS-RV, 8.8%). Among various EUS-BD techniques, EUS-CDS and EUS-HGS are the most frequently reported. Tubular self-expandable metal stents have been traditionally used in EUS-CDS; however, lumen-apposing metal stents have recently gained popularity. A systematic review showed that the rates of early AEs were similar between self-expandable metal stents and lumen-apposing metal stents; however, stent maldeployment was more problematic with lumen-apposing metal stents. Although tubular self-expandable metal stents are used in EUS-HGS, stent maldeployment remains a serious issue, and available devices and technical tips for preventing this AE should be well understood. Furthermore, AEs, such as sepsis, cholangitis, and bleeding, can occur, and strategies to mitigate these risks are essential. In this narrative review, we discussed AEs related to EUS-BD with a focus on management options and strategies for prevention.
当使用内镜逆行胰胆管造影术进行胆道引流失败时，可采用内镜超声引导下胆道引流术（EUS-BD）。最近，它已被用作主要的胆道引流方法，其适应证也有所扩大。由于EUS-BD可能会引发不良事件（AE），如胆漏和支架移位，而这些在内镜逆行胰胆管造影术中不会发生，因此内镜医师需要精通其处理方法和预防技术。EUS-BD包括多种操作，如内镜超声引导下胆总管十二指肠吻合术（EUS-CDS）、内镜超声引导下肝胃吻合术（EUS-HGS）、内镜超声引导下顺行支架置入术（EUS-AS）和内镜超声引导下会师术（EUS-RV）。最近的一项荟萃分析报告称，EUS-BD的总体不良事件发生率为13.7%（EUS-CDS为11.9%；EUS-HGS为15.5%；EUS-AS为9.9%；EUS-RV为8.8%）。在各种EUS-BD技术中，EUS-CDS和EUS-HGS的报道最为频繁。传统上，EUS-CDS使用管状自膨式金属支架；然而，管腔贴壁金属支架最近越来越受欢迎。一项系统评价显示，自膨式金属支架和管腔贴壁金属支架的早期不良事件发生率相似；然而，管腔贴壁金属支架的支架部署不当问题更为突出。虽然EUS-HGS中使用管状自膨式金属支架，但支架部署不当仍然是一个严重问题，应充分了解预防此类不良事件的可用设备和技术技巧。此外，还可能发生败血症、胆管炎和出血等不良事件，减轻这些风险的策略至关重要。在这篇叙述性综述中，我们讨论了与EUS-BD相关的不良事件，重点是管理选择和预防策略。
