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CC BY 4.0 · Journal of Digestive Endoscopy 2023; 14(03): 127-134
DOI: 10.1055/s-0043-1775861
Research Article

Outcomes of Endoscopic Biliary Drainage in Postsurgical Anatomy Using Endoscopic Ultrasound and Enteroscopy: A Comparative Study

Kapil Dev Jamwal 
1   Department of Gastroenterology, Artemis Health Institute, Haryana, India
,
Atul Sharma
1   Department of Gastroenterology, Artemis Health Institute, Haryana, India
,
Rajesh Kumar Padhan
1   Department of Gastroenterology, Artemis Health Institute, Haryana, India
,
Manoj Kumar Sharma
2   Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
› Author Affiliations Funding None.
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Abstract

Objectives Biliary obstruction is a common problem encountered in postsurgical anatomy, which may lead to serious complications if not treated promptly. Endoscopic drainage is a minimally invasive and effective treatment option for such patients. However, the optimal route of endoscopic drainage, either SBE-ERCP (single-balloon enteroscopy with endoscopic retrograde cholangiopancreatography) or EUS-BD (endoscopic ultrasound-guided bile duct drainage), remains controversial. In this study, we aim to evaluate the feasibility and outcomes of endoscopic drainage using these two techniques in postsurgical biliary obstruction over a period of 7 years.

Materials and Methods We conducted a retrospective study of patients who underwent endoscopic drainage for postsurgical biliary obstruction using SBE-ERCP or EUS-BD techniques between 2015 and 2022. The demographic details, clinical presentation, procedure duration, number of sessions required, technical success, complications, and change of procedure from SBE-ERCP to EUS-BD or vice versa were recorded.

Results Seventy-five patients, predominantly females with a mean age of 48 years, underwent endoscopic drainage. Forty-eight patients underwent SBE drainage and 27 patients underwent EUS-HG (EUS-guided hepaticogastrostomy). The mean duration of procedure (44 vs. 77 minutes), number of complications (4 vs. 5), technical success rate (93.5 vs. 85%), change of procedure (0 vs. 3), and number of sessions (1.1 vs. 1.8) were significantly less in the EUS-HG as compared to SBE-ERCP.

Conclusions Endoscopic biliary drainage is feasible, safe, and effective in postsurgical biliary anatomy but requires high technical expertise. The study proposes an algorithm that can be applied in such group of patients to determine the route for choosing the drainage procedure. This requires further validation with a large prospective cohort.

Keywords

cholangitis - pneumobilia - hepaticojejunostomy - ERCP - biliary drainage

Supplementary Material



Publication History

Article published online:
23 October 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Novikov A, Kumta NA, Samstein B, Kahaleh M. Endoscopic ultrasound-guided transhepatic biliary drainage in altered anatomy: a two-step approach. Endoscopy 2016; 48 (Suppl. 01) E287
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Chowdhury SD, Kurien RT, Bharath AK. et al. Endoscopic ultrasound-guided gastrojejunostomy with a Nagi stent for relief of jejunal loop obstruction following hepaticojejunostomy. Endoscopy 2016; 48 (Suppl. 01) E263-E264
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Jirapinyo P, Lee LS. Endoscopic ultrasound-guided pancreatobiliary endoscopy in surgically altered anatomy. Clin Endosc 2016; 49 (06) 515-529
    CrossrefPubMedGoogle Scholar
  • 4 Enestvedt BK, Kothari S, Pannala R. et al; ASGE Technology Committee. Devices and techniques for ERCP in the surgically altered GI tract. Gastrointest Endosc 2016; 83 (06) 1061-1075
    CrossrefPubMedGoogle Scholar
  • 5 Tyberg A, Desai AP, Kumta NA. et al. EUS-guided biliary drainage after failed ERCP: a novel algorithm individualized based on patient anatomy. Gastrointest Endosc 2016; 84 (06) 941-946
    CrossrefPubMedGoogle Scholar
  • 6 Gupta K, Mallery S, Hunter D, Freeman ML. Endoscopic ultrasound and percutaneous access for endoscopic biliary and pancreatic drainage after initially failed ERCP. Rev Gastroenterol Disord 2007; 7 (01) 22-37
    PubMedGoogle Scholar
  • 7 Baniya R, Upadhaya S, Madala S, Subedi SC, Shaik Mohammed T, Bachuwa G. Endoscopic ultrasound-guided biliary drainage versus percutaneous transhepatic biliary drainage after failed endoscopic retrograde cholangiopancreatography: a meta-analysis. Clin Exp Gastroenterol 2017; 10: 67-74
    CrossrefPubMedGoogle Scholar
  • 8 Matsushita M, Shimatani M, Takaoka M, Okazaki K. “Short” double-balloon enteroscope for ERCP with conventional accessories in patients with altered GI anatomy. Gastrointest Endosc 2009; 69 (04) 981-982 , author reply 982
    CrossrefPubMedGoogle Scholar
  • 9 Kawamura T, Uno K, Suzuki A. et al. Clinical usefulness of a short-type, prototype single-balloon enteroscope for endoscopic retrograde cholangiopancreatography in patients with altered gastrointestinal anatomy: preliminary experiences. Dig Endosc 2015; 27 (01) 82-86
    CrossrefPubMedGoogle Scholar
  • 10 Jamwal K, Sharma MK, Sharma BC, Sarin SK. Endoscopic drainage of obstructed biliary system in altered gastrointestinal anatomy: an experience from a tertiary center in India. Indian J Gastroenterol 2018; 37 (04) 299-306
    CrossrefPubMedGoogle Scholar
  • 11 Kiriyama S, Kozaka K, Takada T. et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci 2018; 25 (01) 17-30
    CrossrefPubMedGoogle Scholar
  • 12 Halbert C, Altieri MS, Yang J. et al. Long-term outcomes of patients with common bile duct injury following laparoscopic cholecystectomy. Surg Endosc 2016; 30 (10) 4294-4299
    CrossrefPubMedGoogle Scholar
  • 13 Fong ZV, Pitt HA, Strasberg SM. et al; California Cholecystectomy Group. Diminished survival in patients with bile leak and ductal injury: management strategy and outcomes. J Am Coll Surg 2018; 226 (04) 568-576.e1
    CrossrefPubMedGoogle Scholar
  • 14 MacFadyen Jr BV, Vecchio R, Ricardo AE, Mathis CR. Bile duct injury after laparoscopic cholecystectomy. The United States experience. Surg Endosc 1998; 12 (04) 315-321
    CrossrefPubMedGoogle Scholar
  • 15 Prawdzik C, Belyaev O, Chromik AM, Uhl W, Herzog T. Surgical revision of hepaticojejunostomy strictures after pancreatectomy. Langenbecks Arch Surg 2015; 400 (01) 67-75
    CrossrefPubMedGoogle Scholar
  • 16 Pitt HA, Sherman S, Johnson MS. et al. Improved outcomes of bile duct injuries in the 21st century. Ann Surg 2013; 258 (03) 490-499
    CrossrefPubMedGoogle Scholar
  • 17 Cuendis-Velázquez A, Morales-Chávez C, Aguirre-Olmedo I. et al. Laparoscopic hepaticojejunostomy after bile duct injury. Surg Endosc 2016; 30 (03) 876-882
    CrossrefPubMedGoogle Scholar
  • 18 Pal P, Kulkarni S, Chaudhary H. et al. Single-balloon enteroscopy–guided ERCP in surgically altered anatomy is safe and highly effective: results from a prospective study. J Dig Endosc 2019; 10 (04) 221-227
    Article in Thieme ConnectGoogle Scholar
  • 19 Zielsdorf SM, Klein JJ, Fleetwood VA, Hertl M, Chan EY. Hepaticojejunostomy for benign disease: long-term stricture rate and management. Am Surg 2019; 85 (12) 1350-1353
    CrossrefPubMedGoogle Scholar
  • 20 Yamamoto H, Sekine Y, Sato Y. et al. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc 2001; 53 (02) 216-220
    CrossrefPubMedGoogle Scholar
  • 21 De Koning M, Moreels TG. Comparison of double-balloon and single-balloon enteroscope for therapeutic endoscopic retrograde cholangiography after Roux-en-Y small bowel surgery. BMC Gastroenterol 2016; 16 (01) 98
    CrossrefPubMedGoogle Scholar
  • 22 Tomizawa Y, Sullivan CT, Gelrud A. Single balloon enteroscopy (SBE) assisted therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y anastomosis. Dig Dis Sci 2014; 59 (02) 465-470
    CrossrefPubMedGoogle Scholar
  • 23 Duan F, Cui L, Bai Y, Li X, Yan J, Liu X. Comparison of efficacy and complications of endoscopic and percutaneous biliary drainage in malignant obstructive jaundice: a systematic review and meta-analysis. Cancer Imaging 2017; 17 (01) 27
    CrossrefPubMedGoogle Scholar
  • 24 Itoi T, Ishii K, Sofuni A. et al. Single-balloon enteroscopy-assisted ERCP in patients with Billroth II gastrectomy or Roux-en-Y anastomosis (with video). Am J Gastroenterol 2010; 105 (01) 93-99
    CrossrefPubMedGoogle Scholar
  • 25 Zhao XQ, Dong JH, Jiang K, Huang XQ, Zhang WZ. Comparison of percutaneous transhepatic biliary drainage and endoscopic biliary drainage in the management of malignant biliary tract obstruction: a meta-analysis. Dig Endosc 2015; 27 (01) 137-145
    CrossrefPubMedGoogle Scholar
  • 26 Lee TH, Choi JH, Park H. et al. Similar efficacies of endoscopic ultrasound-guided transmural and percutaneous drainage for malignant distal biliary obstruction. Clin Gastroenterol Hepatol 2016; 14 (07) 1011-1019.e3
    CrossrefPubMedGoogle Scholar
  • 27 Shami VM, Kahaleh M. Endoscopic ultrasonography (EUS)-guided access and therapy of pancreatico-biliary disorders: EUS-guided cholangio and pancreatic drainage. Gastrointest Endosc Clin N Am 2007; 17 (03) 581-593 , vii–viii
    CrossrefPubMedGoogle Scholar
  • 28 Kamei H, Imai H, Onishi Y. et al. Considerable risk of restenosis after endoscopic treatment for hepaticojejunostomy stricture after living-donor liver transplantation. Transplant Proc 2015; 47 (08) 2493-2498
    CrossrefPubMedGoogle Scholar
  • 29 Tomoda T, Tsutsumi K, Kato H. et al. Outcomes of management for biliary stricture after living donor liver transplantation with hepaticojejunostomy using short-type double-balloon enteroscopy. Surg Endosc 2016; 30 (12) 5338-5344
    CrossrefPubMedGoogle Scholar
  • 30 Jamwal KD, Padhan RK, Sharma A. et al. Endoscopic management of biliary obstruction in patients with post-surgical anastomosis and special situations: a concise review. Gastroenterol Hepatol Lett 2012; 2 (02) 18-22
    CrossrefGoogle Scholar
  • 31 Jamwal K, Sharma A, Padhan RK. et al. EUS or enteroscopy guided drainage in altered GI anatomy: an algorithm based individualized approach in obstructive jaundice. J Gastroenterol Hepatol 2019; 34 (S3): 170
    Google Scholar
  • 32 Rai P, Udawat P, Chowdhary SD. et al. Society of Gastrointestinal Endoscopy of India consensus guidelines on endoscopic ultrasound-guided biliary drainage: part I (indications, outcomes, comparative evaluations, training). J Dig Endosc 2023; 14 (01) 30-40
    Article in Thieme ConnectGoogle Scholar
  • 33 Samanta J, Udawat P, Chowdhary SD. et al. Society of Gastrointestinal Endoscopy of India Consensus guidelines on endoscopic ultrasound-guided biliary drainage: part ii (technical aspects). J Dig Endosc 2023; 14 (02) 74-87
    Article in Thieme ConnectGoogle Scholar