Entero-Enteric Lumen Apposing Metal Stents (LAMS) for Biliary Access in Patients with Altered Anatomy

Biliary access in patients with Roux-en-Y hepaticojejunostomy, pancreaticoduodenectomy and duodenal switch can be challenging. Placement of an EUS guided lumen apposing metal stent (LAMS) between the small bowel and the afferent jejunal limb can create an entero-enteric conduit (EUS-EE), allowing for successful endoscopic access to the biliary tree for intervention. In this study, we aim to describe the safety and efficacy of EUS-EE for biliary access.

This is a multicenter retrospective cohort study of patients who underwent EUS-EE for the purpose of biliary intervention at three US centers. The primary outcome was technical success. Secondary outcomes included clinical success, defined as ability to perform intended biliary intervention and adverse events. Descriptive statistics were used to analyze the data.

Eighteen patients underwent EUS-EE for biliary access. The most common surgical anatomy was a Roux-en-Y hepaticojejunostomy (66.6%). 72.2% of patients had either deep enteroscopy or a hepaticogastrostomy attempted for biliary access prior to proceeding with EUS-EE placement. A 20 mm LAMS was used in 12 patients and 15 mm used in 6 patients. Technical and clinical success was achieved in 100% of patients. Two adverse events were noted; 1 patient had a perforation of the opposite jejunal wall that was treated with through-the-scope clips and one patient had minor bleeding that was managed conservatively.

This study demonstrates the feasibility, safety, and efficacy of EUS-EE for management of biliary disorders in patients with surgically altered anatomy. Future large scale multicenter studies are needed to further validate these findings.