Transjejunal biliary interventions: going back to a road less traveled

Abstract

Percutaneous transhepatic biliary interventions are not without risk and potential complications. In patients with bilioenteric anastomosis in whom repeat biliary interventions are expected, percutaneous transjejunal access is a very useful approach that is not frequently used nowadays. We provide a brief review of the history, indications, and current status of transjejunal biliary interventions. Transjejunal biliary access provides a relatively atraumatic pathway to the biliary system in patients that need repeat interventions. Multiple studies have provided convincing data that in appropriately chosen patients receiving a bilioenteric anastomosis, an antecolic limb of jejunum should be placed for subsequent access in biliary intervention.

Therapeutic Role of Subcutaneous Access Loop Created Adjunct to Hepaticojejunostomy for Management of Bile Duct Injury

“…This approach supposedly avoids the hazards of percutaneous transhepatic approach and skin incision and opening of the enteric Roux loop with endoscopic technique. 31,32…”

“…This approach supposedly avoids the hazards of percutaneous transhepatic approach and skin incision and opening of the enteric Roux loop with endoscopic technique. 31,32 Until recently, RYHJ-SA is still in the zone of case series. Technical variations regarding the exact position of the access loop at the anterior abdominal wall (epigastric or right subcostal, and subfacial or subcutaneous) and method of anastomotic site intervention (endoscopic, radiological, or both) have been reported.…”

Long-standing enteroenteric anastomosis with lumen-apposing metal stents to access bilioenteric anastomotic strictures: yes we can!

“…A permanent potential access to the jejunal limb for repeated biliary percutaneous interventions, after hepaticojejunostomy, may be established by fixing under the skin the blind extremity of the limb, which can then be easily punctured under radiologic control. Several series utilizing this technique have been published [4], including the use of a cholangioscope via this route. More recently, another alternative endoscopic method to manage benign biliary strictures in patients with altered anatomy, in order to avoid the percutaneous approach, has been described.…”