EUS-guided biliary drainage via the afferent limb using a forward-viewing echoendoscope for managing...

Choledochojejunal anastomotic strictures are typically treated with endoscopic retrograde cholangiopancreatography through the anastomosis; however, severe strictures can complicate the procedure. Recently, the efficacy of endoscopic ultrasonography-guided biliary drainage using a forward-viewing echoendoscope (FVEUS-BD) has been reported, but the evidence is limited. We aimed to evaluate the efficacy and safety of FVEUS-BD in managing choledochojejunal anastomotic strictures.

This single-center retrospective study included 15 patients who underwent FVEUS-BD between November 2017 and September 2024. The outcomes included technical and clinical success rates, adverse events, time to recurrent biliary obstruction, and stent-free achievement rate.

Fifteen patients underwent FVEUS-BD with reconstruction methods including the modified Child in 86.7% (13/15) and Roux-en-Y in 13.3% (2/15). A total of 53.3% (8/15) of patients had benign strictures and 46.7% (7/15) had malignant strictures. The technical success rate was 93.3% (14/15), and the clinical success rate was 100% (14/14). Adverse events occurred in 21.4% (3/14), including 1 with bile leakage and 2 with recurrent biliary obstruction. The median time to recurrent biliary obstruction was 185 days (95% CI, 185-not available), with no significant difference between malignant and benign groups. A stent-free status was attempted in 75.0% (6/8) of patients with benign strictures. During the observation period (median: 264 days), 50.0% (3/6) required reintervention; however, the anastomosis remained patent, which avoided the need for repuncture.

FVEUS-BD via the afferent limb is an effective and safe rescue method for managing severe choledochojejunal anastomotic strictures. In benign strictures, it offers the potential for achieving a stent-free status and could become a standard approach.