The indications for biliary drainage in cases of pancreatic head tumors with biliary obstruction are well established. ERCP with stent placement has long been the gold standard technique, outperforming surgery or percutaneous drainage. However, in cases of distal malignant biliary obstruction, ERCP becomes more complex, increasing the risk of complications. The advent of therapeutic endoscopic ultrasound (EUS), particularly EUS–choledochoduodenostomy (EUS-CDS) and EUS–hepaticogastrostomy (EUS-HGS), has transformed the management of distal malignant biliary obstruction in the case of pancreatic cancer. EUS-CDS creates communication between the duodenum and the common bile duct. Lumen-apposing metal stents (LAMSs) simplify the procedure, offering high technical and clinical success rates and making the technique easier to perform. Nevertheless, long-term dysfunction rates remain high, necessitating careful definition of procedural indications. EUS-HGS, a more complex technique, connects dilated left bile ducts to the stomach and requires advanced expertise; it is associated with a higher rate of complications. However, its clinical efficacy and technical success are comparable to those of EUS-CDS, and it is the preferred technique in cases of duodenal obstruction or altered anatomy. European and American guidelines currently position EUS-guided biliary drainage (EUS-BD) as a second-line approach after ERCP failure or when ERCP is not feasible, but there is a growing trend toward earlier use. Other techniques are emerging, such as EUS-guided gallbladder drainage (EUS-GBD) and combining EUS-HGS with antegrade stenting, offering valuable alternatives when conventional techniques fail or are inaccessible.
胰腺头部肿瘤伴胆道梗阻的胆道引流指征已明确确立。经内镜逆行胰胆管造影（ERCP）联合支架置入术长期以来被视为金标准技术，其效果优于外科手术或经皮引流。然而，在远端恶性胆道梗阻病例中，ERCP操作更为复杂，并发症风险随之增加。治疗性超声内镜（EUS）技术的出现，特别是EUS引导下胆总管十二指肠吻合术（EUS-CDS）和EUS引导下肝胃吻合术（EUS-HGS），彻底改变了胰腺癌所致远端恶性胆道梗阻的治疗格局。EUS-CDS在十二指肠与胆总管之间建立通道，而管腔对合金属支架（LAMS）的应用简化了操作流程，不仅实现了较高的技术与临床成功率，更显著降低了技术实施难度。尽管如此，该技术的长期功能障碍率仍居高不下，因此需要审慎界定其操作指征。EUS-HGS作为更复杂的技术，将扩张的左肝管与胃相连接，要求术者具备高阶专业技能，其并发症发生率相对较高。但该技术的临床疗效与技术成功率与EUS-CDS相当，且在十二指肠梗阻或解剖结构变异情况下成为首选方案。当前欧美指南将EUS引导下胆道引流（EUS-BD）定位为ERCP失败或不可行时的二线方案，但早期应用趋势日益明显。其他新兴技术如EUS引导下胆囊引流术（EUS-GBD）以及EUS-HGS联合顺行支架置入术，在传统技术失败或无法实施时提供了重要的替代选择。
Advances in EUS-Guided Biliary Drainage for the Management of Pancreatic Cancer
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