International consensus recommendations for difficult biliary access

Liao, Wei‐Chih; Angsuwatcharakon, Phonthep; Isayama, Hiroyuki; Dhir, Vinay; Devereaux, Benedict M.; Khor, Christopher Jen Lock; Ponnudurai, Ryan; Lakhtakia, Sundeep; Lee, Dong Ki; Ratanachu‐ek, Thawee; Yasuda, Ichiro; Dy, Frederick; Ho, Shiaw Hooi; Makmun, Dadang; Liang, Huei‐Lung; Draganov, Peter V.; Rerknimitr, Rungsun; Wang, Hsiu Po

doi:10.1016/j.gie.2016.09.037

Cited by 105 publications

(99 citation statements)

References 76 publications

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“…In recent years, EUS-guided biliary drainage has emerged as an alternative to percutaneous and surgical drainage in cases where ERCP techniques are difficult or not possible [2]. Here we present two cases of successful EUS-guided biliary drainage through hepaticogastrostomy and choledochoduodenostomy.…”

Section: Discussionmentioning

confidence: 94%

“…On the other hand, EUS-guided procedures have the advantage of being entirely performed intraluminally. EUS-guided therapy includes direct transgastric or transduodenal stenting, rendezvous techniques, and anterograde transpapillary stent insertion, although experience with these techniques is still limited [2]. We report and describe two cases of successful biliary decompression through direct transluminal stenting using EUS guidance.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic Ultrasound-Guided Biliary Drainage in Two Patients with Difficult Biliary Access

Libânio

Giestas

Martı́nez-Ares

et al. 2017

GE Port J Gastroenterol

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Introduction: Endoscopic retrograde cholangiopancreatography is the method of choice for biliary drainage, although in some cases standard biliary access is difficult or even impossible. Endoscopic ultrasound (EUS)-guided endoluminal procedures are an alternative in these cases, although experience with these techniques is still limited. Clinical Case: We present two cases of successful EUS-guided biliary drainage. In the first case, a hepaticogastrostomy was performed in a patient with stage IV gastric adenocarcinoma with obstructive jaundice due to compression of the hilum, where malignant gastric stenosis and previous palliative gastrojejunostomy precluded access to the second part of the duodenum. In the second case, a patient with a pancreatic head adenocarcinoma with duodenal invasion that precluded major papillae identification was submitted to a choledochoduodenostomy. Both procedures occurred without immediate or delayed adverse events, with technical and clinical success. Discussion: Although experience with EUS-guided biliary drainage is still limited, its efficacy and safety is favorable when compared with percutaneous and surgical drainage, and should be considered an alternative to these techniques where sufficient expertise exists.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Endoscopic Ultrasound-Guided Biliary Drainage in Two Patients with Difficult Biliary Access

Libânio

Giestas

Martı́nez-Ares

et al. 2017

GE Port J Gastroenterol

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“…Success selective bile duct cannulation during ERCP can be achieved after a few attempts with standard guidewireassisted cannulation in around 80% of cases. Recent guidelines recommended early applying advanced techniques in difficult canulation cases, including; needle-knife precut methods or transpancreatic sphincterotomy with the recommendation of prophylactic pancreatic stents (PPS) insertion in these cases [1][2][3] . In our study, secondary cannulation performed with needle-knife fistulotomy technique in 80 patients (12.8%), transpancreatic sphincterotomy in 28 patients (4.45%), and an additional needle-knife incision was needed in 14 patients (2.24%) when TPS failed to reach deep biliary cannulations.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, additional cannulation methods are often needed in difficult cannulation cases. Difficult cannulation is frequently reported as a risk factor for adverse events with a probability of failed biliary cannulation ranges from 5% to 18% of cases [1][2][3] .…”

Section: Introductionmentioning

confidence: 99%

Prospective Evaluation of Transpancreatic Sphincterotomy Comparing to Needle-knife Precut in Difficult Biliary Cannulation: Short-and Long-term Outcomes

Tabak

2020

Preprint

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Background/Aims: Transpancreatic sphincterotomy (TPS) can be an alternative approach of biliary access in difficult cannulation cases. We aimed to prospectively evaluate the efficacy and safety of TPS compared to needle-knife precut (NKP), considering the late consequences of both techniques. Methods: A total of 122 enrolled patients have been divided into three groups based on the applied secondary cannulation techniques. Selective cannulation success, ERCP procedure findings, and immediate adverse events were compared between groups. We investigated the long-term outcomes during six-month after the procedure. Results: Successful selective cannulation was achieved in 92.9% with TPS similarly to other groups. The mean procedure time was shorter in the TPS group without significant difference. Using TPS did not affect the rate of post-ERCP pancreatitis (PEP) with less frequent post-ERCP bleeding and perforation after TPS compared to NKP, without significant difference. Patients who received TPS, NKP, or both had no symptoms related to papillary stenosis or chronic pancreatitis during the follow-up period. Conclusions: Using TPS was useful to achieve success cannulation in difficult cases with an acceptable PEP rate. Furthermore, it was associated with reducing bleeding and perforation rates comparing with NKP and no differences related to the long term consequences within the follow-up period.

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“…This procedure involves creating a temporary enterobiliary fistula to access the biliary system and obviate cannulation of the ampulla. Number and types of EUS‐guided biliary interventions have been developed in the past few years . Dhir et al .…”

mentioning

confidence: 99%

Role of two‐step endoscopic ultrasonography‐guided antegrade treatment as an option for bile duct stones in patients with surgically altered anatomy

Shimatani

Mitsuyama

Takaoka

et al. 2018

Digestive Endoscopy

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International consensus recommendations for difficult biliary access

Cited by 105 publications

References 76 publications

Endoscopic Ultrasound-Guided Biliary Drainage in Two Patients with Difficult Biliary Access

Endoscopic Ultrasound-Guided Biliary Drainage in Two Patients with Difficult Biliary Access

Prospective Evaluation of Transpancreatic Sphincterotomy Comparing to Needle-knife Precut in Difficult Biliary Cannulation: Short-and Long-term Outcomes

Role of two‐step endoscopic ultrasonography‐guided antegrade treatment as an option for bile duct stones in patients with surgically altered anatomy

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