Current status of endoscopic ultrasound‐guided antegrade intervention for biliary diseases in patients with surgically altered anatomy

Abstract

Endoscopic management of biliary diseases in patients with surgically altered anatomy can be challenging because the altered anatomy makes it difficult to insert an endoscope into the biliary orifice. Even if insertion is feasible, the worse maneuverability of the endoscope and the restriction in available devices and techniques could complicate the procedure. Recently, endoscopic ultrasound‐guided antegrade intervention (EUS‐AG) has been reported as a useful management method for biliary diseases, especially in patients with surgically altered anatomy. In EUS‐AG, the biliary disease is managed in an antegrade fashion through a temporal fistula created under EUS guidance between the intrahepatic biliary duct and upper intestine. In this article, we reviewed the current status of EUS‐AG for each biliary diseases, malignant biliary obstruction, bile duct stones, and benign biliary stricture in patients with surgically altered anatomy.

Society of Gastrointestinal Endoscopy of India Consensus Guidelines on Endoscopic Ultrasound-Guided Biliary Drainage: Part II (Technical Aspects)

“…The commonest adverse effect is pancreatitis. 67 Pancreatitis can be avoided by placing the stent proximal to the papilla. However, that might not be feasible in EUS-AG for MBO as the obstruction might not be far from the papilla.…”

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

“…A biliary puncture was performed using a 19-gauge FNA needle in 12 patients and a 22-gauge needle in five patients, with the accessed duct of B2 in eight patients and B3 in seven patients. The median diameter of the punctured bile duct was 4 mm (IQR, [3][4][5]. The reasons for failed biliary access were insufficient dilation of the IHBD for a puncture in six patients during EUS-AG and technical difficulty in obtaining biliary deep cannulation in 17 patients during BE-ERCP.…”

“…2 Endoscopic ultrasound-guided antegrade treatment (EUS-AG) has emerged as an endoscopic method to treat biliary diseases of the upper intestine. [3][4][5] However, the effectiveness and safety of these procedures have been mainly evaluated in single-arm studies, and there have been few comparative studies. We conducted this study to compare EUS-AG with BE-ERCP in the management of BDS in patients with surgically altered anatomy, to evaluate the merits and demerits of each procedure, and to provide suggestions for future treatment algorithms.…”

“…BE‐ERCP can be performed even in surgically altered anatomical cases and has been reported as a useful procedure to manage BDS 2 . Endoscopic ultrasound‐guided antegrade treatment (EUS‐AG) has emerged as an endoscopic method to treat biliary diseases of the upper intestine 3–5 . However, the effectiveness and safety of these procedures have been mainly evaluated in single‐arm studies, and there have been few comparative studies.…”

Drainage of Afferent Limb Obstruction via the Trans-gastric-bile Duct Formed after Endoscopic Ultrasound-guided Hepaticogastrostomy in a Patient with Pancreatic Cancer

“…Current palliative procedures are based on surgical gastrojejunostomy (GJJ) and endoscopic duodenal stenting with a selfexpanding metal stent (SEMS) (2). These patients are also often complicated with biliary obstruction, but a papillary approach to biliary drainage is difficult in those with GOO (3). Recently, endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS) has been developed as an alternative method of managing these patients (4).…”