Korean J Gastroenterol.  2022 May;79(5):203-209. 10.4166/kjg.2022.064.

Endoscopic Ultrasound-guided Drainage in Pancreatobiliary Diseases

• Kim TH
• Chon HK

• KMID: 2530327
• DOI: http://doi.org/10.4166/kjg.2022.064

Abstract

EUS-guided drainage for gallbladder, bile duct, pancreatic duct, and peripancreatic fluid collection has been performed more frequently in the last decade. The development of dedicated stents and delivery systems for EUS-guided interventions have improved the efficacy and safety of these procedures. Furthermore, the introduction of lumen-apposing metal stents has reduced the complication significantly of endoscopic transmural drainage of pancreatic collections and gallbladder. Recent studies show that EUS-guided drainage of pancreaticobiliary ducts and peripancreatic fluid collection produces good results and low complication rates. This review describes the current position and role of interventional EUS for pancreatobiliary disease in clinical practice.

Keyword

Endosonography; Drainage; Gallbladder; Bile ducts; Pancreas

Figure

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  Fig. 1 Tubular metal stents for EUS-guided drainage. (A) BONA-AL (Standard Sci Tech Inc., Seoul, Korea). (B) BONA-SOO stent (Standard Sci Tech Inc.).

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  Fig. 2 Lumen-apposing metal stents for EUS-guided drainage. (A) AXIOS stent (Boston Scientific, Marlborough, MA, USA). (B) Niti-S SPAXUS stent (Taewoong Medical Co, Ltd, Ilsan, Korea).

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  Fig. 3 Endoscopic ultrasound-guided gallbladder drainage with lumen-apposing metal stents (LAMS) in acute cholecystitis. (A) Computed tomography (CT) showing distended gallbladder with stone suggesting acute cholecystitis. (B) Endoscopic ultrasonography showing a markedly dilatated gallbladder with an expanded flare of LAMS. (C) Fluoroscopic image showing the LAMS. (D) CT showing LAMS placed between the gallbladder and duodenal bulb.

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  Fig. 4 Puncture site and direction (arrow) on endoscopic ultrasound (EUS) and fluoroscopic image for EUS-guided hepaticogastrostomy. (A) EUS image showing dilatated B3 and B2. (B) Fluoroscopic imaging showing cholangiogram of the left intrahepatic bile ducts.

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  Fig. 5 Endoscopic ultrasound-guided hepaticogastrostomy using the partially covered self-expandable metal stent (PCSEMS) for proximal malignant biliary obstruction. (A) Fluoroscopy image showing the cholangiogram of the left intrahepatic duct by contrast injection after a 19-gauge needle puncture. (B) Fluoroscopy image showing the PCSEMS placed between the stomach and the left intrahepatic duct.

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