Percutaneous transjejunal biliary intervention: 10-year experience with access via Roux-en-Y loops.

Abstract

Percutaneous transjejunal biliary access allows repeated interventions over many years with a low morbidity. Routine superficial fixation of Roux-en-Y loops is recommended for all biliary-enteric anastomoses to allow use of this safe and effective approach for any subsequent biliary intervention.

Complex biliary intervention: Percutaneous small bowel access confirmation with cone-beam computed tomography and retrograde biliary obstruction recanalization

“…1 In the majority of the described cases, the jejunal access is fixed to the skin with surgical markers placed during the initial surgery. Accessing non-marked loops has been described previously using percutaneous transhepatic cholangiography to opacify the loops 2,7 or previous CT images to identify the loop. What is common in this series of complex biliary cases is that none of the patients had jejunal access fixed to the skin with surgical markers at the time of initial percutaneous small bowel access, and CBCT was used after small bowel puncture with a 21 G needle to confirm an appropriate access site in these non-fixed loops of small bowel.…”

“…The use of a jejunostomy access to perform biliary interventions is an established technique for the treatment of biliary stenosis in patients with HJ anastomosis. [1][2][3][4] Percutaneous small bowel access can be a challenging procedure if the intestinal loop is not fixed to the anterior abdomen with metallic markers usually placed during the initial surgery. 1,2 Fluoroscopic aids in locating a target loop of bowel such as iodinated contrast and air can quickly move out of the bowel, and do not exclude an interposed segment of colon between the percutaneous access site and the target loop of small bowel.…”

Interventional radiology in treatment of biliodigestive anastomoses strictures

“…Наружновнутреннее дренирование желчных протоков обеих долей печени. а б в оригинальные СТаТьи ный доступ к зоне анастомоза через маркирован-ную петлю кишки и выполнить рентгенохирургиче-ское восстановление проходимости анастомоза под контролем флуороскопии в случае возникновения стриктуры БДА [11]. В наиболее общем виде происхождение и ле-чение стриктуры БДА представлено Saadoon Kadir (2006 г.).…”

Hepaticojejunostomy Anastomotic Strictures

“…23.1b) [1]. Other anecdotal diagnostic modalities include endoscopic retrograde cholangiography, which has been reported to be feasible in 58-93 % of HJ patients [7][8][9], or percutaneous transjejunal endoscopy, which may be facilitated in patients with prior subcutaneous fixation of the Roux-en-Y loop [10,11], but has been also successfully reported using US-guided puncture of non-fixed loops in experienced hands [12,13].…”

“…Even though endoscopy may be facilitated with the use of short-limb Roux-en-Y [44] reconstruction or positioning of the Roux-en-Y loop on the duodenum, it should be restricted to experienced centers in the setting of therapeutic evaluation. The percutaneous transjejunal approach represents a valuable alternative to the endoscopic approach with satisfactory long-term results but is also restricted to very few experienced centers [12,13]. Finally, the "rendez-vous" technique, which combines both endoscopic and percutaneous approaches, may be useful in complex situations.…”