Endoscopy 2020; 52(S 01): S125
DOI: 10.1055/s-0040-1704385
ESGE Days 2020 oral presentations
Saturday, April 25, 2020 11:00 – 13:00 EUS- guided therapy: From training to complications Liffey Meeting Room 3
© Georg Thieme Verlag KG Stuttgart · New York

TRANSJEJUNAL ERCP (TJ-ERCP) VIA EUS-GUIDED ENTERO-ANASTOMOSES (EUS-EA) IN ROUX-EN-Y-HEPATICOJEJUNOSTOMY (RYHJ): SHORT AND LONG-TERM OUTCOMES OF A VARIANT EUS-DIRECTED ERCP IN A CHALLENGING PATIENT POPULATION

C Chavarria
1   Hospital Universatorio Río Hortega, Valladolid, Spain
,
AYC Lopez
2   Hospital Universitario Rio Hortega, Valladolid, Spain
,
R Kunda
3   Department of Surgical Endoscopy, Aarhus University Hospital, Aarhus, Denmark
,
M De Benito
2   Hospital Universitario Rio Hortega, Valladolid, Spain
,
R Soto Solis
2   Hospital Universitario Rio Hortega, Valladolid, Spain
,
M Aerts
4   Department of Gastroenterology-Hepatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
,
MA Gallardo
2   Hospital Universitario Rio Hortega, Valladolid, Spain
,
FJG Alonso
2   Hospital Universitario Rio Hortega, Valladolid, Spain
,
S Bazaga
2   Hospital Universitario Rio Hortega, Valladolid, Spain
,
R Sanchez-Ocaña
2   Hospital Universitario Rio Hortega, Valladolid, Spain
,
JT Tejada
5   Hospital Universitario Río Hortega, Valladolid, Spain
,
C De la Serna
2   Hospital Universitario Rio Hortega, Valladolid, Spain
,
M Perez-Miranda
2   Hospital Universitario Rio Hortega, Valladolid, Spain
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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Aims EUS-directed transGastric ERCP (EDGE) is gaining acceptance in RY gastric bypass (RYGB). Short-term outcomes of similar LAMS-based EUS-directed ERCP have been reported in mixed non-RYGB altered anatomy patients. Endoscopic biliary drainage of RYHJ strictures +/- hepatolithiasis is challenging. An endoscopic approach to biliary drainage in RYHJ might improve outcomes and decrease patient discomfort.

Aims: To assess feasibility and clinical outcomes of TJ-ERCP via EUS-EA with LAMS in patients with RYHJ and failed standard biliary access.

Methods 44 Consecutive RYHJ patients [27(61.3%) male; mean (SD) age 60(10.9) years] with biliary obstruction (BO) who underwent attempted EUS-EA with LAMS for biliary access between 2012-2019 were icluded from two Centers. We describe baseline demographics, procedure details and clinical outcomes. Short-term clinical success: BO resolution without relapses within 30 days. Long-term clinical success: removal of indwelling percutaneous biliary drainage catheters with no recurrences or unscheduled reinterventions within 365 days +/- stricture resolution/complete stone clearance.

Results Benign BO etiology in 37(84%). Median (IQR) time between surgical RYHJ and EUS-EA was 4.2(4.3) years. 35(79.5%) patients had previous biliary drainage attempts (endoscopy, PTBD and/or surgery) with a median (IQR) of 2.5(1-5) failed/unsuccessful procedures. EUS-EA succeeded in 43/44(97.7%). 15mm LAMS was used in 41/43(95.3%). Type of EUS-EA: 13/43(30.2%) gastro-jejunostomy, 27/43(62.8%) duodeno-jejunostomy and 3/43 jejuno-jejunostomy. Single-session ERCP in 10/43 (23.2%). Median (IQR) time between EUS-EA and index TJ-ERCP was 7(2-7) days. There were 4/44(9%) adverse events (2 severe) and 2 LAMS dislodgements. Type of interventions: dilations, stent insertion/removal, lithotripsy, stone removal, cholangioscopy. Technically successful drainage was achieved in 42/43(97.3%) with short-term clinical success in 39/43(90.7%). Long-term success in 31/43(72%) after a median (IQR) of 2(2-3) TJ-ERCPs and a median (IQR) follow-up of 555(357-884) days.

Conclusions TJ-ERCP via EUS-EA with LAMS is feasible in most RYHJ patients despite prior failed biliary drainage. Long-term resolution is achieved in 70% and often requires iterative endoscopy.