Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is considered to be the gold standard for diagnosis and interventions in biliopancreatic diseases. However, ERCP in patients with surgically altered anatomy (SAA) appears to be more difficult compared to cases with normal anatomy. Since the production of a balloon enteroscope (BE) for small intestine disorders, BE had also been used for biliopancreatic diseases in patients with SAA. Since the development of BE-assisted ERCP, the outcomes of procedures, such as stone extraction or drainage, have been reported as favorable. Recently, an interventional endoscopic ultrasound (EUS), such as EUS-guided biliary drainage (EUS-BD), has been developed and is available mainly for patients with difficult cases of ERCP. It is a good option for patients with SAA. The effectiveness of interventional EUS for patients with SAA has been reported. Both BE-assisted ERCP and interventional EUS have advantages and disadvantages. The choice of procedure should be individualized to the patient’s condition or the expertise of the endoscopists. The aim of this review article is to discuss recent advances in interventional ERCP and EUS for patients with SAA.
Highlights
There is a large variety of biliary tract diseases, such as bile duct stones and benign/malignant biliary strictures
Despite the high effectiveness reported for balloon enteroscope (BE)-assisted endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy (SAA), it has several challenges for successful completion of procedures
Has been traditionally performed in these patients despite percutaneous transhepatic biliary drainage (PTBD) being associated with a higher adverse event rate than ERCP [50]
Summary
There is a large variety of biliary tract diseases, such as bile duct stones and benign/malignant biliary strictures. Selective biliary cannulation and subsequent procedures, such as stone extraction or drainage, are more difficult in patients with SAA than cases with normal anatomy. One study from a tertiary referral endoscopy center reported that the afferent loop intubation and cannulation success rates using side-viewing duodenoscope in patients with Billroth II gastrectomy were 86.7% (618/713 patients) and. Another systematic review and meta-analysis reported that the afferent loop intubation and cannulation success rates using a forward-viewing endoscope in patients with Billroth II gastrectomy were 91.1% and 92.3%. The success rates of cannulation using the forward-viewing endoscope with cap-fitting (93.7%) was higher than the forward-viewing endoscope without cap-fitting (89.2%) [8] These studies showed the usefulness of a conventional side or forward-viewing scope in patients with Billroth II gastrectomy. We discuss recent advances in interventional ERCP and EUS for patients with SAA
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