A review of endoscopic ultrasound guided endoscopic retrograde cholangiopancreatography techniques in patients with surgically altered anatomy

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is the primary therapeutic intervention for pancreaticobiliary duct diseases. Surgically altered anatomy (SAA) makes performing successful ERCP challenging. In this review article the concept of endoscopic ultrasound guided pancreaticobiliary drainage (EUS-PBD) in cases of SAA where conventional ERCP fails or is not possible will be reviewed. EUS-PBD serves as an emerging and promising alternative for pancreaticobiliary therapy in the hands of skilled endoscopists compared to conventional therapies such as device-assisted ERCP, laparoscopic-assisted ERCP, or percutaneous drainage. The purpose of this review is to discuss the rationale, technique and current published outcomes on EUS-PBD for SAA.

Endoscopic ultrasound-guided biliary drainage for malignant biliary obstruction with surgically altered anatomy: a multicenter prospective registration study

“…Three major techniques are available for drainage via the IHBD: transmural biliary stenting, antegrade biliary stenting, and the rendezvous technique. 7,41 Because the rendezvous technique requires endoscopic access to the papilla or anastomosis, transmural or antegrade biliary stenting is preferentially performed for SAA patients. Although little information exists on whether transmural or antegrade stenting is more appropriate, our previous study showed that transmural stenting combined with antegrade stenting contributed to long stent patency.…”

Endoscopic ultrasound for choledocholithiasis in Billroth II altered anatomy

“…Ведение пациентов с послеоперационно изменённой анатомией является реально существующей проблемой, связанной с возрастанием количества пациентов, подвергшихся бариатрической хирургии, а также операциям по поводу как доброкачественных, так и злокачественных поражений верхних отделов ЖКТ или панкреато-билиарной зоны, включая резекцию желудка по Бильрот-2 или панкреатодуоденальную резекцию [1] Известны сообщения о технических трудностях панкреатобилиарной эндоскопии у пациентов при резекции желудка по Бильрот-2, когда исследование головки поджелудочной железы и холедоха сопряжено с трудной интубацией приводящей петли вследствие выраженного изгиба, фиксации кишки, изменённой анатомией [2,3]. В случае безуспешной ЭРПХГ может применяться ЧЧХГ с дренированием, которая также имеет свои ограничения и осложнения [4].…”

Efficacy and Safety of Percutaneous Transhepatic Cholangioscopy with the Spyglass DS Direct Visualization System in Patients with Surgically Altered Anatomy: A Pilot Study

“…The complication rate of the procedure has been reported to reach 20% and the steep learning curve associated with the procedure may be problematic. [6][7][8] Percutaneous transhepatic biliary drainage (PTBD) is an established technique that may be indicated in cases of previously failed ERCP, particularly in those involving a surgically altered anatomy. 9,10 However, the specimen adequacy and diagnostic sensitivity of tissue obtained through PTBD may be unsatisfactory, and bile duct stone clearance with PTBD alone can be difficult.…”

“…The complication rate of the procedure has been reported to reach 20% and the steep learning curve associated with the procedure may be problematic. 6 - 8 …”