Biliopancreatic Endoscopy in Altered Anatomy

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Surgical Anatomy

Background:

• Altered upper gastrointestinal (GI) anatomy post-surgery presents challenges for diagnostic and therapeutic endoscopy, particularly for biliopancreatic diseases.
• Common surgeries like esophagectomy, gastrectomy, and pancreaticoduodenectomy significantly modify GI anatomy.
• Advancements in technology have improved endoscopic success rates in these complex cases.

Purpose of the Study:

• To systematically review and identify evidence on biliopancreatic endoscopic techniques used in patients with post-surgical upper GI anatomical alterations.
• To assess the efficacy and safety of various endoscopic approaches in managing biliopancreatic conditions in altered anatomy.

Main Methods:

• Systematic literature search of major databases (PubMed, MEDLINE, Cochrane Library, SCOPUS).
• Extraction of study-level data including patient numbers, anatomical alterations, endoscopic techniques, success rates, and adverse events.
• Inclusion of 52 articles comprising retrospective studies, prospective studies, and case reports.

Main Results:

• Multiple endoscopic techniques were identified for biliopancreatic diseases in altered anatomy, including enteroscopy-assisted ERCP, laparoscopic-assisted ERCP, and EUS-directed interventions.
• Techniques evaluated include double/single balloon enteroscopy-ERCP, spiral enteroscopy-ERCP, EUS-directed transgastric ERCP, and percutaneous assisted trans-prosthetic endoscopic therapy.
• High success rates (often >90%) and a low incidence of endoscopic-related adverse events were reported across various techniques.

Conclusions:

• Novel endoscopic techniques are valuable for managing biliopancreatic diseases in patients with post-surgical upper GI alterations.
• Consideration of these advanced techniques should be based on the specific surgical history, reported success rates, and adverse event profiles.
• Further evaluation of these techniques can optimize patient outcomes in complex endoscopic scenarios.