Background and Aims Endoscopic ultrasonography (EUS)-directed transenteric endoscopic retrograde cholangiopancreatography (ERCP) (EUS-directed transenteric ERCP [EDEE]) using a lumen-apposing metal stent (LAMS) is a novel biliary drainage technique for patients with surgically altered anatomy. The study aimed to evaluate the feasibility, safety, and effectiveness of EDEE. Methods This is a multicenter, retrospective study. We included consecutive patients with altered anatomy who underwent an EDEE. Surgical anatomy configuration, prior biliary drainage, and ERCP indications were collected. The EUS-guided anastomosis technique was assessed. The primary outcome was the technical success of the EDEE. The secondary outcomes were the clinical success and the adverse events (AEs). Results Ninety-four ERCPs were performed in 55 patients (60 ± 16.2 years old, 56.4% male). The most frequent surgical anatomy was Roux-en-Y hepaticojejunostomy ( n = 23, 41.8%) and a prior biliary drainage was performed in 28 patients (50.9%). Benign strictures were the most frequent indication (58.2%). The most frequent techniques to identify the biliary limb were EUS imaging alone ( n = 14, 25.5%) and EUS-guided puncture of the biliary limb with retrograde opacification of the surgical hepaticojejunostomy ( n = 14, 25.5%). The procedure was performed using a direct freehand approach ( n = 49, 89.1%). Technical and clinical success rates of EDEE were 87.3% and 93.8%, respectively. The overall AE rate was 20% (9.1% LAMS-related). The rate of persistent fistula was 30.6% with a median follow-up period of 3 months. Conclusions The EDEE technique offers a new and effective approach for biliary drainage in patients with surgically altered anatomy, particularly in benign indications and/or when several ERCPs are expected.
Transenteric endoscopic retrograde cholangiopancreatography via endoscopic ultrasound–guided anastomosis using lumen-apposing metal stents in patients with surgically altered anatomy (with video) / Perez-Cuadrado-Robles, E., Bronswijk, M., Tyberg, A., Vanella, G., Anderloni, A., Hindryckx, P., Shahid, H., Arcidiacono, P.G., Ratone, J.-P., Sarkar, A., Binda, C., Andalib, I., Laleman, W., Poley, J.-W., Haba, M.G., Caillol, F., Fabbri, C., Boeken, T., Becq, A., Monino, L., et al.. - In: GASTROINTESTINAL ENDOSCOPY. - ISSN 0016-5107. - 103:5(2026), pp. 994-1002. [10.1016/j.gie.2025.10.005]
Transenteric endoscopic retrograde cholangiopancreatography via endoscopic ultrasound–guided anastomosis using lumen-apposing metal stents in patients with surgically altered anatomy (with video)
Vanella G.;Arcidiacono P. G.;
2026-01-01
Abstract
Background and Aims Endoscopic ultrasonography (EUS)-directed transenteric endoscopic retrograde cholangiopancreatography (ERCP) (EUS-directed transenteric ERCP [EDEE]) using a lumen-apposing metal stent (LAMS) is a novel biliary drainage technique for patients with surgically altered anatomy. The study aimed to evaluate the feasibility, safety, and effectiveness of EDEE. Methods This is a multicenter, retrospective study. We included consecutive patients with altered anatomy who underwent an EDEE. Surgical anatomy configuration, prior biliary drainage, and ERCP indications were collected. The EUS-guided anastomosis technique was assessed. The primary outcome was the technical success of the EDEE. The secondary outcomes were the clinical success and the adverse events (AEs). Results Ninety-four ERCPs were performed in 55 patients (60 ± 16.2 years old, 56.4% male). The most frequent surgical anatomy was Roux-en-Y hepaticojejunostomy ( n = 23, 41.8%) and a prior biliary drainage was performed in 28 patients (50.9%). Benign strictures were the most frequent indication (58.2%). The most frequent techniques to identify the biliary limb were EUS imaging alone ( n = 14, 25.5%) and EUS-guided puncture of the biliary limb with retrograde opacification of the surgical hepaticojejunostomy ( n = 14, 25.5%). The procedure was performed using a direct freehand approach ( n = 49, 89.1%). Technical and clinical success rates of EDEE were 87.3% and 93.8%, respectively. The overall AE rate was 20% (9.1% LAMS-related). The rate of persistent fistula was 30.6% with a median follow-up period of 3 months. Conclusions The EDEE technique offers a new and effective approach for biliary drainage in patients with surgically altered anatomy, particularly in benign indications and/or when several ERCPs are expected.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
