内镜技术在肝脏疾病诊断治疗中的应用及发展

陆靖怡; 曲颖; 陆伦根

doi:10.12449/JCH240431

内镜技术在肝脏疾病诊断治疗中的应用及发展

DOI: 10.12449/JCH240431

上海交通大学医学院附属第一人民医院消化科，上海 200080

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：陆靖怡负责查阅分析文献，撰写论文；曲颖负责论文修改；陆伦根负责构思文章框架，指导写作及文章定稿。

详细信息

通信作者:
陆伦根， lungenlu1965@163.com （ORCID： 0000-0002-1533-4068）

计量
- 文章访问数: 87
- HTML全文浏览量: 49
- PDF下载量: 16
- 被引次数: 0
出版历程
- 收稿日期: 2023-08-16
- 录用日期: 2023-09-18
- 出版日期: 2024-04-11

Application and development of endoscopic techniques in the diagnosis and treatment of liver diseases

Department of Gastroenterology，The First People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine，Shanghai 200080，China

More Information

Corresponding author: LU Lungen， lungenlu1965@163.com （ORCID： 0000-0002-1533-4068）

摘要

摘要: 肝脏疾病是全球最主要的健康问题之一，早期诊断和及时干预治疗是预防肝脏相关疾病发病率和死亡率的关键。内镜技术的发展为肝病的诊断和干预提供了新的手段。本文介绍了超声内镜引导下肝穿刺活检的技术进展与优势，简述内镜技术在治疗肝脓肿/肝囊肿、肝脏疾病引起的门静脉高压以及治疗肝脏肿瘤等介入技术的应用与发展，展示了在国内较为新颖的内镜下减重技术在治疗非酒精性脂肪性肝病/非酒精脂肪性肝炎的功效与前景。内镜技术有望在国内的肝脏相关疾病中得到更好、更广泛的应用与探索，为患者与医生提供更多选择。
- 肝疾病 /
- 内窥镜 /
- 内镜超声引导细针穿刺
Abstract: Liver disease is one of the most important health problems around the world， and early diagnosis and timely intervention and treatment are the key to preventing liver-related morbidity and mortality rates. The development of endoscopic techniques has provided new diagnostic and intervention methods for liver diseases. This article reviews the application and development of endoscopic techniques in liver diseases from the following aspects： the technical advances and advantages of endoscopic ultrasound-guided liver biopsy； the application and development of endoscopic techniques in the treatment of portal hypertension caused by liver abscess/hepatic cyst and liver diseases， as well as interventional techniques in the treatment of liver tumors； the efficacy and prospects of the endoscopic techniques for weight loss， which are relatively new in China， in the treatment of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis. Endoscopic techniques may hold promise for wide clinical application and exploration in in liver-related diseases in China， so as to provide more options for patients and doctors.
- Liver Diseases /
- Endoscopes /
- Endoscopic Ultrasound-Guided Fine Needle Aspiration

HTML全文

表 1 临床常见肝穿刺活检方法比较^［2-6］

Table 1. Comparison of common clinical methods of liver biopsy

项目	EUS-LB	经皮肝穿刺活检	经颈静脉肝穿刺活检
可检测的肝叶范围^［3］	双叶	双叶，大部分在右叶	局部右叶
是否可以多模式评估	+++	+	-
标本长度及完整性	++	+++	+
对腹水患者是否安全	是	否	是
对凝血功能异常患者是否安全	是	否	是
穿刺至大血管/其他器官的概率^［5］	小	中	小
是否受肥胖影响^［6］	否	是	否
对小转移灶敏感性	+++	+	-
术后不良反应/并发症风险	+	++	+
价格	++	+	++

下载: 导出CSV

表 2 常见内镜下减重技术^［39-50］

Table 2. Common endoscopic bariatric and metabolic therapies

干预路径	内镜下减重技术	FDA批准	ASMBS认证	对NAFLD疗效
胃相关	胃内球囊置入术（IGB）	√	√	改善^［40-42］
	内镜下袖状胃成形术	√	×	改善^［43］
	内镜胃折叠术	√	×	改善^［44］
	跨幽门梭子装置	√	×	无报道
小肠相关	十二指肠空肠旁路套管	×	×	改善^［45-48］
	十二指肠黏膜表面重修术	×	×	改善^［49-50］
	磁铁下近端空肠-回肠窦道建立术	×	×	无报道
注：FDA，美国食品药品监督管理局；ASMBS，美国代谢和肥胖外科学会。

下载: 导出CSV

参考文献(50)

[1]	DEVARBHAVI H, ASRANI SK, ARAB JP, et al. Global burden of liver disease: 2023 update[J]. J Hepatol, 2023, 79( 2): 516- 537. DOI: 10.1016/j.jhep.2023.03.017.
[2]	TEHAMI NA, SIAU K, BUCHANAN R, et al. Endoscopic ultrasound-guided liver biopsy: Down but not out[J]. Gut, 2022, 71( 3): 654- 655. DOI: 10.1136/gutjnl-2021-324815.
[3]	KHURANA S, BUTT W, KHARA HS, et al. Bi-lobar liver biopsy via EUS enhances the assessment of disease severity in patients with non-alcoholic steatohepatitis[J]. Hepatol Int, 2019, 13( 3): 323- 329. DOI: 10.1007/s12072-019-09945-4.
[4]	JOHNSON KD, LAOVEERAVAT P, YEE EU, et al. Endoscopic ultrasound guided liver biopsy: Recent evidence[J]. World J Gastrointest Endosc, 2020, 12( 3): 83- 97. DOI: 10.4253/wjge.v12.i3.83.
[5]	SCHULMAN AR, THOMPSON CC, ODZE R, et al. Optimizing EUS-guided liver biopsy sampling: Comprehensive assessment of needle types and tissue acquisition techniques[J]. Gastrointest Endosc, 2017, 85( 2): 419- 426. DOI: 10.1016/j.gie.2016.07.065.
[6]	HASHIMOTO R, CHANG KJ. Endoscopic ultrasound guided hepatic interventions[J]. Dig Endosc, 2021, 33( 1): 54- 65. DOI: 10.1111/den.13661.
[7]	HASAN MK, KADKHODAYAN K, IDRISOV E, et al. Endoscopic ultrasound-guided liver biopsy using a 22-G fine needle biopsy needle: A prospective study[J]. Endoscopy, 2019, 51( 9): 818- 824. DOI: 10.1055/a-0967-3640.
[8]	BANG JY, WARD TJ, GUIRGUIS S, et al. Radiology-guided percutaneous approach is superior to EUS for performing liver biopsies[J]. Gut, 2021, 70( 12): 2224- 2226. DOI: 10.1136/gutjnl-2021-324495.
[9]	PATEL HK, SAXENA R, RUSH N, et al. A comparative study of 22G versus 19G needles for EUS-guided biopsies for parenchymal liver disease: Are thinner needles better?[J]. Dig Dis Sci, 2021, 66( 1): 238- 246. DOI: 10.1007/s10620-020-06165-x.
[10]	DAWOD E, NIETO J, SAAB S. Endoscopic ultrasound-guided liver biopsy: Where do we stand?[J]. Am J Gastroenterol, 2022, 117( 2): 205- 208. DOI: 10.14309/ajg.0000000000001551.
[11]	SHAH RM, SCHMIDT J, JOHN E, et al. Superior specimen and diagnostic accuracy with endoscopic ultrasound-guided liver biopsies using 19-gauge versus 22-gauge core needles[J]. Clin Endosc, 2021, 54( 5): 739- 744. DOI: 10.5946/ce.2020.212.
[12]	MOHAN BP, MADHU D, REDDY N, et al. Diagnostic accuracy of EUS-guided fine-needle biopsy sampling by macroscopic on-site evaluation: A systematic review and meta-analysis[J]. Gastrointest Endosc, 2022, 96( 6): 909- 917. e 11. DOI: 10.1016/j.gie.2022.07.026.
[13]	CHIN YK, ASOKKUMAR R. Endoscopic ultrasound-guided drainage of difficult-to-access liver abscesses[J]. SAGE Open Med, 2020, 8: 2050312120921273. DOI: 10.1177/2050312120921273.
[14]	BARON TH, LAPPAS BM. Successful EUS-guided cystoduodenostomy of a large hepatic cyst causing biliary obstruction[J]. Gastrointest Endosc, 2021, 93( 4): 981- 982. DOI: 10.1016/j.gie.2020.12.003.
[15]	D\U 02 BCERRICO F, DERHY S, FAZI M, et al. EUS-guided endoscopic internal drainage with lumen-apposing metal stent for symptomatic hepatic cysts: A case series(with video)[J]. Endosc Int Open, 2023, 11( 1): E76- E80. DOI: 10.1055/a-1968-7596.
[16]	RANA SS, AHMED S, SHARMA R, et al. Safety and efficacy of EUS-guided drainage of liver abscess: A single-center experience[J]. Endosc Ultrasound, 2020, 9( 5): 350- 351. DOI: 10.4103/eus.eus_41_20.
[17]	YAMAMOTO K, ITOI T, TSUCHIYA T, et al. EUS-guided drainage of hepatic abscess in the right side of the liver of a patient with Chilaiditi syndrome[J]. VideoGIE, 2017, 2( 11): 299- 300. DOI: 10.1016/j.vgie.2017.06.013.
[18]	CARBAJO AY, BRUNIE VEGAS FJ, GARCÍA-ALONSO FJ, et al. Retrospective cohort study comparing endoscopic ultrasound-guided and percutaneous drainage of upper abdominal abscesses[J]. Dig Endosc, 2019, 31( 4): 431- 438. DOI: 10.1111/den.13342.
[19]	VENKATESH V, RANA SS, KUMAR A, et al. Hepatobiliary and Pancreatic: EUS-guided drainage of a ruptured amoebic liver abscess in a child[J]. J Gastroenterol Hepatol, 2020, 35( 6): 921. DOI: 10.1111/jgh.15014.
[20]	TAKAHASHI K, OHYAMA H, NAGASHIMA H, et al. Successful endoscopic treatment of huge infected biloma and hepatic abscess after endoscopic ultrasound-guided hepaticogastrostomy with brain abscess[J]. Clin J Gastroenterol, 2022, 15( 5): 988- 993. DOI: 10.1007/s12328-022-01659-9.
[21]	de NUCCI G, DELLA CORTE C, REATI R, et al. Endoscopic ultrasound-guided radiofrequency ablation for hepatocellular carcinoma in cirrhosis: A case report test for efficacy and future perspectives[J]. Endosc Int Open, 2020, 8( 11): E1713- E1716. DOI: 10.1055/a-1236-3105.
[22]	CARRARA S, ARCIDIACONO PG, ALBARELLO L, et al. Endoscopic ultrasound-guided application of a new internally gas-cooled radiofrequency ablation probe in the liver and spleen of an animal model: A preliminary study[J]. Endoscopy, 2008, 40( 9): 759- 763. DOI: 10.1055/s-2008-1077520.
[23]	LI T, KHOKHLOVA T, MALONEY E, et al. Endoscopic high-intensity focused US: Technical aspects and studies in an in vivo porcine model(with video)[J]. Gastrointest Endosc, 2015, 81( 5): 1243- 1250. DOI: 10.1016/j.gie.2014.12.019.
[24]	NAKAJI S, HIRATA N, IWAKI K, et al. Endoscopic ultrasound(EUS)-guided ethanol injection for hepatocellular carcinoma difficult to treat with percutaneous local treatment[J]. Endoscopy, 2012, 44(Suppl 2 UCTN): E 380. DOI: 10.1055/s-0032-1309918.
[25]	HU YH, TUO XP, JIN ZD, et al. Endoscopic ultrasound(EUS)-guided ethanol injection in hepatic metastatic carcinoma: A case report[J]. Endoscopy, 2010, 42( Suppl 2): E256- E257. DOI: 10.1055/s-0030-1255653.
[26]	JIANG TA, DENG Z, TIAN G, et al. Efficacy and safety of endoscopic ultrasonography-guided interventional treatment for refractory malignant left-sided liver tumors: A case series of 26 patients[J]. Sci Rep, 2016, 6: 36098. DOI: 10.1038/srep36098.
[27]	LEE EW, SHAHROUKI P, ALANIS L, et al. Management options for gastric variceal hemorrhage[J]. JAMA Surg, 2019, 154( 6): 540- 548. DOI: 10.1001/jamasurg.2019.0407.
[28]	LIM YS. Practical approach to endoscopic management for bleeding gastric varices[J]. Korean J Radiol, 2012, 13( Suppl 1): S40- S44. DOI: 10.3348/kjr.2012.13.S1.S40.
[29]	LAHOTI S, CATALANO MF, ALCOCER E, et al. Obliteration of esophageal varices using EUS-guided sclerotherapy with color Doppler[J]. Gastrointest Endosc, 2000, 51( 3): 331- 333. DOI: 10.1016/s0016-5107(00)70363-4.
[30]	BICK BL, AL-HADDAD M, LIANGPUNSAKUL S, et al. EUS-guided fine needle injection is superior to direct endoscopic injection of 2-octyl cyanoacrylate for the treatment of gastric variceal bleeding[J]. Surg Endosc, 2019, 33( 6): 1837- 1845. DOI: 10.1007/s00464-018-6462-z.
[31]	ROBLES-MEDRANDA C, OLEAS R, VALERO M, et al. Endoscopic ultrasonography-guided deployment of embolization coils and cyanoacrylate injection in gastric varices versus coiling alone: A randomized trial[J]. Endoscopy, 2020, 52( 4): 268- 275. DOI: 10.1055/a-1123-9054.
[32]	FUJII-LAU LL, LAW R, WONG KEE SONG LM, et al. Endoscopic ultrasound(EUS)-guided coil injection therapy of esophagogastric and ectopic varices[J]. Surg Endosc, 2016, 30( 4): 1396- 1404. DOI: 10.1007/s00464-015-4342-3.
[33]	BHAT YM, WEILERT F, FREDRICK RT, et al. EUS-guided treatment of gastric fundal varices with combined injection of coils and cyanoacrylate glue: A large U.S. experience over 6 years(with video)[J]. Gastrointest Endosc, 2016, 83( 6): 1164- 1172. DOI: 10.1016/j.gie.2015.09.040.
[34]	RYOU M, DEWITT JM, DAS KK, et al. AGA clinical practice update on interventional EUS for vascular investigation and therapy: Commentary[J]. Clin Gastroenterol Hepatol, 2023, 21( 7): 1699- 1705.e2. DOI: 10.1016/j.cgh.2023.03.027.
[35]	ZHANG W, PENG CY, ZHANG S, et al. EUS-guided portal pressure gradient measurement in patients with acute or subacute portal hypertension[J]. Gastrointest Endosc, 2021, 93( 3): 565- 572. DOI: 10.1016/j.gie.2020.06.065.
[36]	CHOI AY, KOLB J, SHAH S, et al. Endoscopic ultrasound-guided portal pressure gradient with liver biopsy: 6 years of endo-hepatology in practice[J]. J Gastroenterol Hepatol, 2022, 37( 7): 1373- 1379. DOI: 10.1111/jgh.15875.
[37]	ESTES C, RAZAVI H, LOOMBA R, et al. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease[J]. Hepatology, 2018, 67( 1): 123- 133. DOI: 10.1002/hep.29466.
[38]	CHALASANI N, YOUNOSSI Z, LAVINE JE, et al. The diagnosis and management of non-alcoholic fatty liver disease: Practice guideline by the American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology[J]. Gastroenterology, 2012, 142( 7): 1592- 1609. DOI: 10.1053/j.gastro.2012.04.001.
[39]	DAYYEH BK ABU, BAZERBACHI F, GRAUPERA I, et al. Endoscopic bariatric and metabolic therapies for non-alcoholic fatty liver disease[J]. J Hepatol, 2019, 71( 6): 1246- 1248. DOI: 10.1016/j.jhep.2019.07.026.
[40]	SALOMONE F, CURRENTI W, MAGRÌ G, et al. Effects of intragastric balloon in patients with nonalcoholic fatty liver disease and advanced fibrosis[J]. Liver Int, 2021, 41( 9): 2112- 2116. DOI: 10.1111/liv.14917.
[41]	LEE YM, LOW HC, LIM LG, et al. Intragastric balloon significantly improves nonalcoholic fatty liver disease activity score in obese patients with nonalcoholic steatohepatitis: A pilot study[J]. Gastrointest Endosc, 2012, 76( 4): 756- 760. DOI: 10.1016/j.gie.2012.05.023.
[42]	BAZERBACHI F, VARGAS EJ, RIZK M, et al. Intragastric balloon placement induces significant metabolic and histologic improvement in patients with nonalcoholic steatohepatitis[J]. Clin Gastroenterol Hepatol, 2021, 19( 1): 146- 154. e 4. DOI: 10.1016/j.cgh.2020.04.068.
[43]	HAJIFATHALIAN K, MEHTA A, ANG B, et al. Improvement in insulin resistance and estimated hepatic steatosis and fibrosis after endoscopic sleeve gastroplasty[J]. Gastrointest Endosc, 2021, 93( 5): 1110- 1118. DOI: 10.1016/j.gie.2020.08.023.
[44]	JIRAPINYO P, ZUCKER SD, THOMPSON CC. Regression of hepatic fibrosis after endoscopic gastric plication in nonalcoholic fatty liver disease[J]. Am J Gastroenterol, 2023, 118( 6): 983- 990. DOI: 10.14309/ajg.0000000000002087.
[45]	RUBAN A, GLAYSHER MA, MIRAS AD, et al. A duodenal sleeve bypass device added to intensive medical therapy for obesity with type 2 diabetes: a RCT[M/OL]. Southampton(UK): NIHR Journals Library, 2020.[ 2023-08-07]. http://www.ncbi.nlm.nih.gov/books/NBK564056/. http://www.ncbi.nlm.nih.gov/books/NBK564056/
[46]	KARLAS T, PETROFF D, FEISTHAMMEL J, et al. Endoscopic bariatric treatment with duodenal-jejunal bypass liner improves non-invasive markers of non-alcoholic steatohepatitis[J]. Obes Surg, 2022, 32( 8): 2495- 2503. DOI: 10.1007/s11695-022-06150-5.
[47]	de JONGE C, RENSEN SS, KOEK GH, et al. Endoscopic duodenal-jejunal bypass liner rapidly improves plasma parameters of nonalcoholic fatty liver disease[J]. Clin Gastroenterol Hepatol, 2013, 11( 11): 1517- 1520. DOI: 10.1016/j.cgh.2013.07.029.
[48]	REN MT, ZHOU XX, YU MS, et al. Prospective study of a new endoscopic duodenal-jejunal bypass sleeve in obese patients with nonalcoholic fatty liver disease(with video)[J]. Dig Endosc, 2023, 35( 1): 58- 66. DOI: 10.1111/den.14409.
[49]	MINGRONE G, van BAAR AC, DEVIÈRE J, et al. Safety and efficacy of hydrothermal duodenal mucosal resurfacing in patients with type 2 diabetes: The randomised, double-blind, sham-controlled, multicentre REVITA-2 feasibility trial[J]. Gut, 2022, 71( 2): 254- 264. DOI: 10.1136/gutjnl-2020-323608.
[50]	van BAAR ACG, BEUERS U, WONG K, et al. Endoscopic duodenal mucosal resurfacing improves glycaemic and hepatic indices in type 2 diabetes: 6-month multicentre results[J]. JHEP Rep, 2019, 1( 6): 429- 437. DOI: 10.1016/j.jhepr.2019.10.006.