Outcomes of biliopancreatic EUS in patients with surgically altered upper gastrointestinal anatomy: a multicenter study

Abstract

Background and study aims Little is known about outcomes of biliopancreatic endosonography (EUS) in patients with surgically altered upper gastrointestinal (gastrointestinal) anatomy. We aimed to assess the rate of procedural success and EUS-related adverse events (AEs), according to post-surgical anatomies.

Patients and methods Retrospective study including patients with post-surgical altered upper gastrointestinal anatomy who underwent EUS for evaluation of the biliopancreatic region between January 2008 and June 2018 at eight European centers.

Results Of 242 patients (162 males, mean age 66.4 ± 12.5), 86 had (35.5 %) Billroth II, 77 (31.8 %) pancreaticoduodenectomy, 23 (9.5 %) Billroth I, 19 (7.9 %) distal esophagectomy, 15 (6.2 %) total gastrectomy, 14 (5.8 %) sleeve gastrectomy, and eight (3.3 %) Roux-en-Y. Sleeve gastrectomy, Billroth I, and pancreaticoduodenectomy were associated with high rates of success (100 %, 95.7 %, and 92.2 %, respectively). Visualization of the head of the pancreas was significantly impacted by total gastrectomy, Billroth II, and Roux-en-Y (success rates 6.7 %, 53.7 %, and 57.1 %, respectively). Examination of the pancreatic body and tail was impaired in esophagectomy and total gastrectomy (82.4 % and 71.4 %, respectively). Technical success and diagnostic accuracy of EUS-guided tissue acquisition (EUS-TA) was 78.2 % and 71.3 % (95 % CI, 60.6–80.5), respectively. Four (1.6 %) AEs were observed: one mucosal tearing in a Billroth II patient, one cardiac arrest in a distal esophagectomy patient, one bleed after EUS-TA in a Billroth I patient, and one acute pancreatitis after EUS-TA in a sleeve gastrectomy patient.

Conclusions The yield of bilio-pancreatic EUS is dependent on lesion location and surgery type. Before considering EUS in these patients, one must carefully consider whether the lesion may be approachable by EUS.

Publikationsverlauf

Eingereicht: 26. Januar 2020

Angenommen: 30. März 2020

Artikel online veröffentlicht:
16. Juni 2020

• References

• 1 Chahal P, Baron TH, Topazian MD. et al. Endoscopic retrograde cholangiopancreatography in post-Whipple patients. Endoscopy 2006; 38: 1241-1245
• 2 Hintze RE, Adler A, Veltzke W. et al. Endoscopic access to the papilla of Vater for endoscopic retrograde cholangiopancreatography in patients with Billroth II or Roux-en-Y gastrojejunostomy. Endoscopy 1997; 29: 69-73
• 3 Wright BE, Cass OW, Freeman ML. ERCP in patients with long-limb Roux-en-Y gastrojejunostomy and intact papilla. Gastrointest Endosc 2002; 56: 225-232
• 4 Lee JH, Topazian M. Pancreatic endosonography after Billroth II gastrectomy. Endoscopy 2004; 36: 972-975
• 5 Wilson JA, Hoffman B, Hawes RH. et al. EUS in patients with surgically altered upper gastrointestinal anatomy. Gastrointest Endosc 2010; 72: 947-953
• 6 Fusaroli P, Ceroni L, Caletti G. Forward-view endoscopic ultrasound: a systematic review of diagnostic and therapeutic applications. Endosc Ultrasound 2013; 2: 64-70
• 7 Kawakami H, Yoshimasa K. New curved linear echoendoscope for endoscopic ultrasonography-guided fine-needle aspiration in patients with Roux-en-Y reconstruction (with videos). Endosc Ultrasound 2018; 7: 128-129
• 8 Itoi T, Itokawa F, Sofuni A. et al. Endoscopic ultrasonography-guided fine needle aspiration biopsy in a patient with prior Billroth II gastrectomy. Dig Endosc 2011; 23 (Suppl. 01) 162-163
• 9 Ban T, Kawakami H, Kubota Y. et al. Endoscopic ultrasonography-guided fine-needle biopsy from the pancreatic head of a patient with Roux-en-Y reconstruction. Endoscopy 2018; 50: E202-E204
• 10 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
• 11 Wani S, Muthusamy VR, McGrath CM. et al. AGA White Paper: Optimizing Endoscopic Ultrasound–Guided Tissue Acquisition and Future Directions. Clin Gastroenterol Hepatol 2018; 16: 318-327
• 12 Klapman JB, Chang KJ, Lee JG. et al. Negative predictive value of endoscopic ultrasound in a large series of patients with a clinical suspicion of pancreatic cancer. Am J Gastroenterol 2005; 100: 2658-2661
• 13 Armellini E, Manfrin E, Trisolini E. et al. Histologic retrieval rate of a newly designed side-bevelled 20G needle for EUS-guided tissue acquisition of solid pancreatic lesions. United European Gastroenterol J 2019; 7: 96-104
• 14 Tanaka K, Hayashi T, Utsunomiya R. et al. Endoscopic ultrasound-guided fine needle aspiration for diagnosing pancreatic mass in patients with surgically altered upper gastrointestinal anatomy [Epub ahead of print]. Dig Endosc 2020;
• 15 Jenssen C, Faiss S, Nürnberg D. Complications of endoscopic ultrasound and endoscopic ultrasound-guided interventions – results of a survey among German centers. Z Gastroenterol 2008; 46: 1177-1184
• 16 Jenssen C, Alvarez-Sánchez MV, Napoléon B. et al. Diagnostic endoscopic ultrasonography: Assessment of safety and prevention of complications. World J Gastroenterol 2012; 18: 4659-4676
• 17 Bove V, Tringali A, Familiari P. et al. ERCP in patients with prior Billroth II gastrectomy: report of 30 yearsʼ experience. Endoscopy 2015; 47: 611-616