Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(04): E394-E400
DOI: 10.1055/a-2032-3077
Original article

Endoscopic entero-enteral bypass to treat postsurgical benign complications of hepatico-jejunostomy: Update of a 7-year single-center experience

Massimiliano Mutignani
1   Digestive and Interventional Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
,
Edoardo Forti
1   Digestive and Interventional Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
,
Francesco Pugliese
1   Digestive and Interventional Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
,
Marcello Cintolo
1   Digestive and Interventional Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
,
Giulia Bonato
1   Digestive and Interventional Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
,
Marianna Bravo
1   Digestive and Interventional Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
,
Lorenzo Dioscoridi
1   Digestive and Interventional Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background and study aims Since 2014, we have been using a new endoscopic approach to improve management of biliary adverse events (BAEs) after bilio-digestive anastomosis. We provide an update about our experience at 7 years.

Patients and methods Patients with BAEs on hepatico-jejunostomy underwent entero-enteral endoscopic by-pass (EEEB) creation between the duodenal/gastric wall and the biliary jejunal loop. Evaluation of results during our seven-year experience was performed.

Results Eighty consecutive patients (32 patients from Jan 2014 to Dec 2017 and 48 patients from Jan 2018 to Jan 2021) underwent EEEB, which was successful in all but one patient. The cumulative AEs rate was 32 %. Endoscopic retrograde cholangiography (ERC) through the EEEB successfully treated all types of BAEs in these patients. Cumulative disease recurrence was 3.8 % (three patients) and was retreated through the EEEB.

Conclusions The update of our experience with EEEB confirmed that in patients with BAEs after bilio-digestive anastomosis, EEEB allows successful long-term treatment of different BAEs in a tertiary referral center with an acceptable rate of related AEs.



Publication History

Received: 10 August 2022

Accepted after revision: 01 February 2023

Article published online:
24 April 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

Comment to this article:

Endoscopy International Open – recently publishedEndoscopy 2023; 55(07): 685-685
DOI: 10.1055/a-2050-7971

 

  • References

  • 1 Itokawa F, Itoi T, Ishii K. et al. Single- and double-ballon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in patients with Roux-en-Y plus hepaticojejunostomy anastomosis and Whipple resection. Dig Endosc 2014; 26: 136-143
    CrossrefPubMedSearch in Google Scholar
  • 2 Tomoda T, Tsutsumi K, Okada H. et al. Comparison between Roux-en-Y patients with and without gastrectomy during endoscopic retrograde cholangiopancreatography using a short double-baloon enteroscope. Dig Endosc 2015; 27: 775
    CrossrefPubMedSearch in Google Scholar
  • 3 Zouhairi ME, Watson JB, Desai SV. et al. Rotational assisted endoscopic retrograde cholangiopancreatography in patients with reconstructive gastrointestinal surgical anatomy. World J Gastrointest Endosc 2015; 7: 278-282
    CrossrefPubMedSearch in Google Scholar
  • 4 Blanco-Velasco G, Chavez-Pina H. Treatment of a bile duct leak with ERCP double-baloon enteroscopy in a patient with Roux-en-Y reconstruction. Endoscopy 2016; 48: E197-E198
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Kedia P, Kumta NA, Sharaiha R. et al. Bypassing the bypass: EUS-directed transgastric ERCP for Roux-en-Y anatomy. Gastrointest Endosc 2015; 81: 223-224
    CrossrefPubMedSearch in Google Scholar
  • 6 Giovannini M, Bories E, Napoleon B. et al. 855 multicentric randomized phase II study: percutaneous biliary drainage vs EUS guided biliary drainage: results of the intermediate analysis. Gastrointest Endosc 2015; 81: AB174
    CrossrefPubMedSearch in Google Scholar
  • 7 Khan MA, Baron TH, Kamal F. et al. Efficacy of self-expandable metal stents in management of benign biliary strictures and comparison with multiple plastic stents: a meta-analysis. Endoscopy 2017; 49: 682-694
    Thieme ConnectPubMedSearch in Google Scholar
  • 8 Mutignani M, Manta R, Pugliese F. et al. Endoscopic ultrasound-guided duodenojejunal anastomosis to treat postsurgical Roux-en-Y hepaticojejunostomy stricture: a dream or a reality?. Endoscopy 2015; 47: E350-E351
    Thieme ConnectPubMedSearch in Google Scholar
  • 9 Majmudar K, Wagh MS. EUS-guided jejuno-jejunostomy with lumen-apposing metal stent for complete jejunal obstruction after gastric bypass. Gastrointest Endosc 2016; 84: 853-854
    CrossrefPubMedSearch in Google Scholar
  • 10 Tyberg A, Perez-Miranda M, Sanchez-Ocana R. et al. Endoscopic ultrasound-guided gastrojejunostomy with lumen-apposing metal stent: a multicenter, international experience. Endosc Int Open 2016; 4: E276-E281
    Thieme ConnectPubMedSearch in Google Scholar
  • 11 Ngamreuengphong S, Nieto J, Kunda R. et al. Endoscopic ultrasound-guided creation of a transgastric fistula for the management of hepatobiliary disease in patients with Roux-en-Y gastric bypass. Endoscopy 2017; 49: 549-552
    Thieme ConnectPubMedSearch in Google Scholar
  • 12 Mutignani M, Forti E, Larghi A. et al. Endoscopic entero-enteral bypass: an effective new approach to the treatment of postsurgical complications of hepaticojejunostomy. Endoscopy 2019; 51: 1146-1150
    Thieme ConnectPubMedSearch in Google Scholar
  • 13 Nass KJ, Zwager LW, van der Vlugt M. et al. Novel classification for adverse events in GI endoscopy: the AGREE classification. Gastrointest Endosc 2022; 95: 1078-1085.e8
    Search in Google Scholar
  • 14 Cantwell CP, Pena CS, Gervais DA. et al. Thirty years' experience with balloon dilation of benign postoperative biliary strictures: long-term outcomes. Radiology 2008; 249: 1050-1057
    CrossrefPubMedSearch in Google Scholar
  • 15 Dhondt E, Vanlangenhove P, Van Vlierberghe H. et al. Benign anastomotic biliary strictures untreatable by ERCP: a novel percutaneous balloon dilatation technique avoiding indwelling catheters. Eur Radiol 2019; 29: 636-644
    CrossrefPubMedSearch in Google Scholar
  • 16 Dioscoridi L, Forti E, Pugliese F. et al. Buried lumen-apposing metal stent after gastrojejunal bypass. Endoscopy 2020; 52: E134-E135
    Thieme ConnectPubMedSearch in Google Scholar