Transjejunal biliary interventions: going back to a road less traveled

Area of Science:

• Gastroenterology
• Interventional Radiology
• Biliary Medicine

Background:

• Percutaneous transhepatic biliary interventions carry inherent risks and complications.
• Patients with bilioenteric anastomosis often require repeat biliary interventions.
• Percutaneous transjejunal access is an underutilized but valuable technique in this patient population.

Purpose of the Study:

• To review the history, indications, and current status of transjejunal biliary interventions.
• To highlight the benefits of transjejunal access for repeat biliary interventions in specific patient groups.
• To emphasize the importance of jejunal limb placement for future access.

Main Methods:

• Review of historical data and current literature on transjejunal biliary interventions.
• Analysis of indications and outcomes for percutaneous transjejunal access.
• Discussion of surgical considerations for facilitating transjejunal access.

Main Results:

• Transjejunal biliary access provides a less traumatic pathway to the biliary system.
• This approach is particularly useful in patients requiring multiple biliary interventions.
• Evidence supports the use of an antecolic limb of jejunum for subsequent access.

Conclusions:

• Percutaneous transjejunal access is a valuable, albeit underused, method for biliary interventions.
• Strategic surgical planning, including antecolic jejunal limb placement, is crucial for successful repeat interventions.
• This approach enhances patient management by offering a safer access route.