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What You Need to Know Before Performing Endoscopic Ultrasound-guided Hepaticogastrostomy

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초록

Endoscopic retrograde cholangiopancreatography (ERCP) is the primary treatment modality for bile duct obstruction. WhenERCP is unsuccessful, percutaneous transhepatic biliary drainage can be an alternative method. Endoscopic ultrasound-guidedbiliary drainage (EUS-BD) has emerged as a treatment option for biliary obstruction, especially after ERCP failure. EUS-BDoffers transluminal intrahepatic and extrahepatic drainage through a transgastric and transduodenal approach. EUS-guidedhepaticogastrostomy (EUS-HGS) is an excellent choice for patients with hilar strictures or those with a surgically altered anatomy. The optimal steps in EUS-HGS are case selection, bile duct visualization, puncture-site selection, wire insertion and manipulation,tract dilation, and stent placement. Caution should be taken at each step to prevent complications. Dedicated devices for EUS-HGShave been developed to improve the technical success rate and reduce complications. This technical review focuses on the essentialpractical points at each step of EUS-HGS.

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is the primary treatment modality for bile duct obstruction. WhenERCP is unsuccessful, percutaneous transhepatic biliary drainage can be an alternative method. Endoscopic ultrasound-guidedbiliary drainage (EUS-BD) has emerged as a treatment option for biliary obstruction, especially after ERCP failure. EUS-BDoffers transluminal intrahepatic and extrahepatic drainage through a transgastric and transduodenal approach. EUS-guidedhepaticogastrostomy (EUS-HGS) is an excellent choice for patients with hilar strictures or those with a surgically altered anatomy. The optimal steps in EUS-HGS are case selection, bile duct visualization, puncture-site selection, wire insertion and manipulation,tract dilation, and stent placement. Caution should be taken at each step to prevent complications. Dedicated devices for EUS-HGShave been developed to improve the technical success rate and reduce complications. This technical review focuses on the essentialpractical points at each step of EUS-HGS.

참고문헌 (62)

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