Gastrointestinal endoscopy · 2025
Transenteric endoscopic retrograde cholangiopancreatography via endoscopic ultrasound-guided anastomosis using lumen-apposing metal stents in patients with surgically altered anatomy (with video).
СтатьяVideo-Audio MediaМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Pérez-Cuadrado-Robles Enrique, Bronswijk Michiel, Tyberg Amy, Vanella Giuseppe, Anderloni Andrea, Hindryckx Pieter, Shahid Haroon, Arcidiacono Paolo Giorgio, Ratone Jean-Philippe, Sarkar Avik, Binda Cecilia, Andalib Iman, Laleman Wim, Poley Jan-Werner, Haba Mariano Gonzalez, Caillol Fabrice, Fabbri Carlo, Boeken Tom, Becq Aymeric, Monino Laurent, Cellier Christophe, Kahaleh Michel, van der Merwe Schalk
Аннотация
BACKGROUND AND AIMS: Endoscopic ultrasonography (EUS)-directed transenteric endoscopic retrograde cholangiopancreatography (ERCP) (EUS-directed transenteric ERCP [EDEE]) using a lumen-apposing metal stent (LAMS) is a novel biliary drainage technique for patients with surgically altered anatomy. The study aimed to evaluate the feasibility, safety, and effectiveness of EDEE.
METHODS: This is a multicenter, retrospective study. We included consecutive patients with altered anatomy who underwent an EDEE. Surgical anatomy configuration, prior biliary drainage, and ERCP indications were collected. The EUS-guided anastomosis technique was assessed. The primary outcome was the technical success of the EDEE. The secondary outcomes were the clinical success and the adverse events (AEs).
RESULTS: Ninety-four ERCPs were performed in 55 patients (60 ± 16.2 years old, 56.4% male). The most frequent surgical anatomy was Roux-en-Y hepaticojejunostomy (n = 23, 41.8%) and a prior biliary drainage was performed in 28 patients (50.9%). Benign strictures were the most frequent indication (58.2%). The most frequent techniques to identify the biliary limb were EUS imaging alone (n = 14, 25.5%) and EUS-guided puncture of the biliary limb with retrograde opacification of the surgical hepaticojejunostomy (n = 14, 25.5%). The procedure was performed using a direct freehand approach (n = 49, 89.1%). Technical and clinical success rates of EDEE were 87.3% and 93.8%, respectively. The overall AE rate was 20% (9.1% LAMS-related). The rate of persistent fistula was 30.6% with a median follow-up period of 3 months.
CONCLUSIONS: The EDEE technique offers a new and effective approach for biliary drainage in patients with surgically altered anatomy, particularly in benign indications and/or when several ERCPs are expected.
METHODS: This is a multicenter, retrospective study. We included consecutive patients with altered anatomy who underwent an EDEE. Surgical anatomy configuration, prior biliary drainage, and ERCP indications were collected. The EUS-guided anastomosis technique was assessed. The primary outcome was the technical success of the EDEE. The secondary outcomes were the clinical success and the adverse events (AEs).
RESULTS: Ninety-four ERCPs were performed in 55 patients (60 ± 16.2 years old, 56.4% male). The most frequent surgical anatomy was Roux-en-Y hepaticojejunostomy (n = 23, 41.8%) and a prior biliary drainage was performed in 28 patients (50.9%). Benign strictures were the most frequent indication (58.2%). The most frequent techniques to identify the biliary limb were EUS imaging alone (n = 14, 25.5%) and EUS-guided puncture of the biliary limb with retrograde opacification of the surgical hepaticojejunostomy (n = 14, 25.5%). The procedure was performed using a direct freehand approach (n = 49, 89.1%). Technical and clinical success rates of EDEE were 87.3% and 93.8%, respectively. The overall AE rate was 20% (9.1% LAMS-related). The rate of persistent fistula was 30.6% with a median follow-up period of 3 months.
CONCLUSIONS: The EDEE technique offers a new and effective approach for biliary drainage in patients with surgically altered anatomy, particularly in benign indications and/or when several ERCPs are expected.