Patient profile, procedure technique and clinical outcomes of transjejunal ERCP (TJ-ERC) via EUS-guided entero-anastomosis (EUS-EA) using lumen-apposing metal stents (LAMS) in Roux-en-Y Hepaticojejunostomy (RYHJ)

Aims Biliary obstruction(BO) in RYHJ is currently managed percutaneously, particularly when strictures or hepatolithiasis dictate iterative revisions, or adhesions preclude enteroscopy-ERCP. EUS-EA with LAMS could facilitate ERCP in RYHJ. Aim: To assess feasibility, safety and efficacy of EUS-EA-assisted TJ-ERCP in RYHJ patients.

Methods Consecutive patients from 2 centers with BO and RYHJ who underwent TJ-ERCP between 2014-2022 were reviewed. Technical success: TJ-ERCP completion. Short-term clinical success: BO resolution without relapses <30 days. Long-term clinical success: removal of percutaneous biliary drains with no relapses/unplanned reinterventions <365 days ± stricture resolution/stone clearance [1] [2] [3] [4].

Results 73 patients [48(65,75%) male;64(11.71)years]underwent attempted TJ-ERCP. BO was benign in 64(88%). Median time(IQR) between index RYHJ and EUS-EA:7.4(12.03)years. EUS-EA was successful in 69/73 (94.5%). Type of EUS-EA: 39.7% gastro-jejunostomy; 41,1% duodeno-jejunostomy (10, bulb; 20, 2^nd duodenum); 19.2% jejuno-jejunostomy. Same-session ERCP in 28/43 (40.6%). AEs: 6/73 (8.5%). 7 LAMS dislodgements (all managed endoscopically). Long-term clinical success: 59/73 (80.8%) (▶[Table 1]).

Table 1  Results.

Conclusions EUS-EA assisted TJ-ERCP appears safe and effective. Technical success/patient tolerance appear better than in enteroscopy-ERCP/PTBD, respectively. Underlying disease is more challenging than in EDG. Definitive resolution is achieved in 80.8%. TJ-ERCP might be the primary approach to BO in RYHJ.

Publication History

Article published online:
14 April 2023

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