Combined endoscopic retrograde and endosonography-guided (CERES) cholangiography for interventional repair of transected bile ducts after cholecystectomy: treatment approaches and outcomes

Definitive endoscopic repair of transected bile ducts after cholecystectomy using EUS-guided hepaticogastrostomy and retrograde cholangioperitoneoscopy

“… 4 EUS-hepaticogastrostomy can be attempted in TBD patients with dilated intrahepatic ducts in tandem with ERCP, thus avoiding subsequent percutaneous transhepatic biliary drainage and its risks of fluid and electrolyte loss. 2 , 5 Combining ERCP and endosonography-guided interventional cholangiography (a procedure termed CERES) appears feasible and convenient in TBDs, 4 as it does in hilar malignancy. 7 CERES restores internal biliary drainage, allowing acute leakage control in TBD patients.…”

“… 1 , 3 The gap across the transection measured 40 mm. A hepaticogastrostomy to liver segment 3 was performed with an 8-mm-diameter × 8-cm-long antimigration-covered biliary metal stent (BCG Hanarostent; M.I.Tech, Gyeonggi-do, South Korea), as reported 4 ( Fig. 1 ).…”

“…The nasobiliary tube was identified next to a Jackson-Pratt drain under cholangioperitoneoscopy and gently pulled back from the patient’s mouth to help grasp the guidewire with a tripod forceps. The guidewire was retrieved into the duodenum and outside of the duodenoscope, as described 4 , 5 , 6 ( Fig. 4 ).…”

“…Standard treatment involves surgical repair, often with prior external biliary drainage. 1 Percutaneous rendezvous 2 , 3 or interventional EUS 4 can reconnect a transected bile duct (TBD); however, guidewire recanalization remains challenging and fails in up to two-thirds of cases. 4 …”

Staged Hepaticogastrostomy (HGS) and Retrograde Cholangioperitoneoscopy (RCPS) to Reconnect a Transected Bile Duct (TBD) after Laparoscopy Cholecystectomy (LC)

“…Abstract Text Standard management of TBD is surgery with prior PTBD. Rendezvous (PMID:29351705) or interventional EUS (PMID:34816304) can reconnect TBDs; yet, recanalization may fail 1 2 .…”