Comparing endoscopic ultrasound‐guided antegrade treatment and balloon endoscopy‐assisted endoscopic retrograde cholangiopancreatography in the management of bile duct stones in patients with surgically altered anatomy: A retrospective cohort study

Abstract

BackgroundEndoscopic ultrasound‐guided antegrade treatment (EUS‐AG) and balloon endoscopy‐assisted endoscopic retrograde cholangiopancreatography (BE‐ERCP) have emerged as useful procedures for managing bile duct stones (BDS) in patients with surgically altered anatomy. However, the comparison between these two procedures has not been well studied.The aim of our study was to compare the clinical outcomes of EUS‐AG and BE‐ERCP for managing BDS in patients with surgically altered anatomy.MethodsThe database was retrospectively evaluated at two tertiary care centers to identify patients with surgically altered anatomy who underwent either EUS‐AG or BE‐ERCP for BDS. Clinical outcomes were compared between the procedures. The success rate of each procedure was evaluated in three steps: endoscopic approach, biliary access, and stone extraction.ResultsAmong the 119 identified patients, 23 had EUS‐AG, and 96 had BE‐ERCP. The overall technical success rates of EUS‐AG and BE‐ERCP were 65.2% (15/23) and 69.8% (67/96), respectively (P = .80). The comparison of each step between the procedures EUS‐AG versus BE‐ERCP was as follows: endoscopic approach, 100% (23/23) versus 88.5% (85/96) (P = .11); biliary access, 73.9% (17/23) versus 80.0% (68/85) (P = .57); stone extraction, 88.2% (15/17) versus 98.5% (67/68) (P = .10). The overall adverse event rate was 17.4% (4/23) versus 7.3% (7/96) (P = .22).ConclusionsBoth EUS‐AG and BE‐ERCP are effective and relatively safe procedures in the management of BDS in patients with surgically altered anatomy. The challenging steps of each procedure might be different, which could help decide which one to use to manage BDS in patients with surgically altered anatomy.

Endoscopic ultrasound-guided antegrade treatment versus balloon enteroscopy endoscopic retrograde cholangiopancreatography for choledocholithiasis in patients with Roux-en-Y gastric bypass: a systematic review and meta-analysis

“…Using the search strategy above, 33 studies were screened, duplicates were removed, and 3 were included ( Fig. 1 ) [ 12 - 14 ]. All included studies were observational.…”

“…The core of our findings indicates that there is no significant difference in the technical and clinical success rates between EUS-AG and BE-ERCP. This outcome suggests that both techniques are equally viable options for endoscopic intervention in RYGB, allowing for flexibility in clinical decision-making based on the practitioner’s expertise and the specific circumstances of each case [ 12 - 14 ]. Itoi et al , in a recent case series of patients with surgically altered anatomy and choledocholithiasis, report a technical success rate of 60% with the EUS-AG technique [ 18 ].…”

EUS Guided antegrade treatment vs Balloon Enteroscopy ERCP for Choledocholithiasis in patients with Roux en Y Gastric Bypass (RYGB) – A Systematic Review and Meta-analysis

“…This outcome suggests that both techniques are equally viable options for endoscopic intervention in RYGB, allowing for exibility in clinical decision-making based on the practitioner's expertise and the speci c circumstances of each case. [12][13][14] Itoi et al report a technical success rate of 60% with EUS-AG technique in a recent case series of patients with surgically altered anatomy and choledocholithiasis. 18 Iwashita et al also reported the results of a prospective study of antegrade stenting in twenty patients with surgically altered anatomy.…”

“…Using the search strategy above, 33 studies were screened, duplicates were removed, and three were included. (Figure 1) [12][13][14] All included studies were observational. 795 patients were included, which also corresponded to the total number of procedures performed including EUS-AG and BE-ERCP.…”

Balloon endoscopy-assisted endoscopic retrograde cholangiopancreatography for hepatolithiasis in patients with hepaticojejunostomy

“…The rate of complete stone removal raised up to 90% by rescue PTBD or EUS-HGS after failed BE-ERCP in this study. EUS-HGS is a potential salvage treatment for hepatolithiasis in patients with SAA [ 15 , 29 ], and there are some case reports for successful removal of hepatolithiasis using HGS route [ 30 ]. Furthermore, direct cholangioscopy through the HGS route and subsequent electrohydraulic lithotripsy under a direct visualization could be an option for large stones [ 31 ].…”