Background If the guidewire becomes kinked by the needle, guidewire manipulation may be difficult, and can cause complications such as guidewire shearing or injury during endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS). To overcome this matter, we have previously described a technical tip for preventing guidewire injury, termed 'liver impaction technique'. However, its technical feasibility has been not reported in the setting of a large patient cohort. Objectives The aim of study was to evaluate the clinical usefulness of the liver impaction technique during EUS-HGS. Design Retrospective, single-center study. Methods This retrospective study included consecutive patients who underwent EUS-HGS between April 2018 and September 2022. The primary outcome of this study was the technical success rate of guidewire insertion using the liver impaction technique. Results A total of 166 patients were enrolled in this study. Initial successful guidewire insertion without using liver impaction technique was obtained in 108 patients (65.1%). Among 58 patients in whom guidewire insertion failed initially, guidewire advancement into the periphery of the bile duct was observed in 32 patients (55.2%) and into a non-interest bile duct branch was observed in 26 patients (44.8%). Liver impaction technique contributed to increasing the technical success rate of guidewire insertion from 65.1% to 95.8%. Overall, adverse events were observed in 12 patients (7.2%; bile peritonitis n = 9, cholangitis n = 3), and these adverse events were Grade I. Among patients who underwent liver impaction technique (n = 58), adverse events were observed in two patients (3.4%; bile peritonitis). Also, guidewire sharing was not observed in any patients during liver impaction technique. Conclusions In conclusion, the liver impaction technique may be helpful during EUS-HGS to obtain successful guidewire insertion into the biliary tract of interest.

中文翻译：

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肝脏嵌塞技术提高了超声内镜引导下肝胃造口术期间导丝插入的技术成功率（附图）。

背景 如果导丝被针扭结，导丝操作可能会很困难，并且可能会导致并发症，例如超声内镜 (EUS) 引导的肝胃造口术 (HGS) 期间导丝剪切或损伤。为了解决这个问题，我们之前描述了一种防止导丝损伤的技术技巧，称为“肝脏嵌塞技术”。然而，其技术可行性尚未在大型患者队列中得到报道。目的 研究的目的是评估 EUS-HGS 期间肝脏撞击技术的临床实用性。设计回顾性、单中心研究。方法 这项回顾性研究纳入了 2018 年 4 月至 2022 年 9 月期间接受 EUS-HGS 的连续患者。这项研究的主要结果是使用肝脏撞击技术插入导丝的技术成功率。结果共有166名患者纳入本研究。108 名患者 (65.1%) 在不使用肝脏撞击技术的情况下首次成功插入导丝。在 58 名最初导丝插入失败的患者中，32 名患者 (55.2%) 观察到导丝进入胆管周围，26 名患者 (44.8%) 观察到导丝进入不感兴趣的胆管分支。肝脏嵌塞技术使导丝置入技术成功率从65.1%提高到95.8%。总体而言，12 名患者（7.2%；胆汁性腹膜炎 n = 9，胆管炎 n = 3）观察到不良事件，这些不良事件为 I 级。在接受肝脏嵌塞技术的患者（n = 58）中，观察到不良事件两名患者（3.4%；胆汁性腹膜炎）。此外，在肝脏嵌塞技术期间，没有在任何患者中观察到导丝共用。结论 总之，肝脏撞击技术可能有助于 EUS-HGS 期间将导丝成功插入目标胆道。