Technical Review of Developments in Endoscopic Ultrasound- Guided Hepaticogastrostomy
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초록
Endoscopic ultrasound-guided biliary drainage has been developed as an alternative method for biliary drainage. EUS-guidedhepaticogastrostomy (EUS-HGS) can be attempted via the trans-gastric route. These procedures are technically complex for tworeasons. First, puncture of the intrahepatic bile duct via the trans-gastric route can be more difficult than that by other approachesbecause of the small diameter of the target site, and guidewire insertion or manipulation is challenging during EUS-HGS. Second,critical adverse events, such as stent migration into the abdominal cavity, could occur because of the greater mobility of the stomachcompared to the duodenum. Therefore, endoscopists should be cautious when performing EUS-HGS. An advantage of EUS-HGSis that it can be performed in patients with complications such as duodenal bulb obstruction or surgically altered anatomy. Recentadvances in technique and improvements in devices and stents for EUS-HGS have shown promise for improving the technicalsuccess rate of EUS-HGS and reducing the rate of adverse events. However, endoscopists should remain aware of the possibility ofcritical adverse events such as stent migration.
Abstract
Endoscopic ultrasound-guided biliary drainage has been developed as an alternative method for biliary drainage. EUS-guidedhepaticogastrostomy (EUS-HGS) can be attempted via the trans-gastric route. These procedures are technically complex for tworeasons. First, puncture of the intrahepatic bile duct via the trans-gastric route can be more difficult than that by other approachesbecause of the small diameter of the target site, and guidewire insertion or manipulation is challenging during EUS-HGS. Second,critical adverse events, such as stent migration into the abdominal cavity, could occur because of the greater mobility of the stomachcompared to the duodenum. Therefore, endoscopists should be cautious when performing EUS-HGS. An advantage of EUS-HGSis that it can be performed in patients with complications such as duodenal bulb obstruction or surgically altered anatomy. Recentadvances in technique and improvements in devices and stents for EUS-HGS have shown promise for improving the technicalsuccess rate of EUS-HGS and reducing the rate of adverse events. However, endoscopists should remain aware of the possibility ofcritical adverse events such as stent migration.
참고문헌 (24)
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