Endoscopic Biliary Drainage in Surgically Altered Anatomy.

Area of Science:

• Gastroenterology
• Endoscopy
• Biliary Interventions

Background:

• Endoscopic retrograde cholangiopancreatography (ERCP) is standard for biliary obstruction but difficult with surgically altered anatomies (SAAs).
• SAAs are increasingly common due to bariatric surgery and pancreatic cancer interventions.
• Traditional alternatives like percutaneous transhepatic biliary drainage (PTBD) or surgery have limitations.

Purpose of the Study:

• To review evolving endoscopic techniques for biliary drainage in patients with SAAs.
• To highlight the role of novel enteroscopy and endoscopic ultrasound (EUS) methods.
• To discuss advancements in overcoming anatomical challenges in ERCP.

Main Methods:

• Review of innovative endoscopic approaches including cap-assisted forward-viewing endoscopy and enteroscopy.
• Detailed examination of various EUS-guided techniques for biliary access and drainage.
• Discussion of specific EUS-based methods like rendezvous, antegrade, transmural, and EUS-directed transgastric ERCP (EDGE).

Main Results:

• While new endoscopic methods enable ERCP in SAAs, they can be complex and time-consuming.
• EUS-based techniques, including rendezvous, antegrade, and transmural approaches, show significant promise.
• The EUS-directed transgastric ERCP (EDGE) procedure is a notable advancement for post-gastric bypass patients.

Conclusions:

• Evolving endoscopic techniques, particularly EUS-guided interventions, are expanding options for biliary drainage in complex anatomies.
• These advancements aim to improve the success rate and accessibility of endoscopic biliary interventions.
• Further development in EUS and enteroscopy holds potential for future innovations in managing biliary obstructions.