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Endoscopic ultrasound-directed transenteric endoscopic retrograde cholangiopancreatography for biliary interventions
Michael Lajin1, Kevin Bui1, Tyler Jackson1
1Sharp HealthCare, San Diego, California, USA.
Background And Aims:
Traditionally, deep enteroscopy, surgery, or percutaneous biliary drains were used to gain access for biliary interventions in patients with Roux-en-Y reconstruction. These methods are cumbersome, less successful than standard ERCP, and carry a higher risk of adverse events (AEs). Transductal and transmural EUS-assisted techniques are increasingly used in these settings. Although EUS-directed transgastric ERCP is mainly used for Roux-en-Y gastric bypass, EUS-directed transenteric ERCP (EDEE) is used for Roux-en-Y hepaticojejunostomy (RYHJ) and Roux-en-Y gastrectomy.
Methods:
In this case series, we presented 3 patients who underwent EDEE for stones, strictures, or both. We highlighted the technical differences between RYHJ and Roux-en-Y gastrectomy, as well as the different methods to distend the targeted small-bowel loop.
Results:
The biliary orifice was easily reached, and biliary interventions were successfully performed in all patients using the necessary accessories. There were no AEs directly related to the procedures.
Conclusions:
EDEE is an important technique for biliary interventions in patients with nongastric bypass Roux-en-Y reconstruction. Further data are needed to assess its long-term effectiveness and safety.
