Endoscopic biliary drainage in patients with surgically altered anatomy: the Street multicenter study

Background and Aims: Endoscopic biliary drainage (BD) in patients with surgical altered anatomy (SAA) is a challenging scenario. Different BD approaches are available but still not standardized, and they rely on local availability and expertise. The aim of this study was to explore the approach to BD in patients with SAA in different centers. Methods: This was a retrospective multicenter cohort study. All adult patients with SAA who underwent endoscopic BD for any indication in the last 5 years were enrolled. Clinical outcomes were evaluated according to the type of surgical reconstruction, the clinical indication, and the type of endoscopic BD technique used. Results: A total of 432 patients were included. Global technical and clinal success of BD was 80.3% and 79.9%, respectively. Outcomes were similar among the different types of surgical reconstruction except for a higher rate of adverse events in patients with Billroth-II reconstruction (14.4%). BD approach in patients with Roux-en-Y reconstruction was heterogeneous with a higher use of more advanced procedures such as device-assisted enteroscopy ERCP and interventional EUS. Interventional EUS procedures were more frequently performed in the last 2-year period showing a higher probability of clinical success (odds ratio, 7.87; 95% CI, 2.56-24.13; P < .001) than the other BD techniques with lower rate of reintervention in the follow-up period. Conclusions: BD in patients with SAA is still associated with suboptimal chance of success in all the different types of reconstruction. The increasing use of interventional EUS procedures in the last years significantly improved outcomes in patients with SAA treated with these techniques.