Endoscopic Ultrasound-Guided Pancreatobiliary Endoscopy in Surgically Altered Anatomy

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) has become the mainstay of therapy for pancreatobiliary diseases. While ERCP is safe and highly effective in the general population, the procedure remains challenging or impossible in patients with surgically altered anatomy (SAA). Endoscopic ultrasound (EUS) allows transmural access to the bile or pancreatic duct (PD) prior to ductal drainage using ERCP-based techniques. Also known as endosonography-guided cholangiopancreatography (ESCP), the procedure provides multiple advantages over overtube-assisted enteroscopy ERCP or percutaneous or surgical approaches. However, the procedure should only be performed by endoscopists experienced in both EUS and ERCP and with the proper tools. In this review, various EUS-guided diagnostic and therapeutic drainage techniques in patients with SAA are examined. Detailed step-by-step procedural descriptions, technical tips, feasibility, and safety data are also discussed.

Endoscopic ultrasound-guided hepaticogastrostomy and antegrade clearance of biliary lithiasis in patients with surgically-altered anatomy

“…EUS-guided pancreaticobiliary therapy is performed in selected tertiary care centers worldwide 8 9 . These procedures require expertise in EUS and ERCP, and can serve as an alternative to percutaneous therapy 10 or ERC using long-length endoscopes.…”

Untitled

“…EUS-guided pancreaticobiliary therapy is performed in selected tertiary care centers worldwide [8,9]. These procedures require expertise in EUS and ERCP, and can serve as an alternative to percutaneous therapy [10] or ERC using long-length endoscopes.…”

EUS-Guided Pancreatic Duct Cannulation

“…Despite being shown to be effective, widespread application of EUS-PDD is limited by its high complication rate, similar to EUS-BD [18,42,54]. In the EUS-RV technique, adverse event rates ranged from 0 to 25% and included pancreatitis, peripancreatic abscess, and pancreatic fluid leakage [26], whereas in EUS-TMD, the adverse event rates ranged from 0% to 67% and included abdominal pain, pancreatitis, bleeding, perforation, shaving of the guidewire coating, peripancreatic abscess, pseudocyst, and stent migration [18,29]. The higher adverse events observed in EUS-TMD may be related to the need for fistula tract dilation and the risk of pancreatic fluid leakage.…”