TEMPORARY EUS-GUIDED ANASTOMOSES (TEAS) TO FACILITATE STAGED ENDOTHERAPY OF COMPLEX BENIGN BILIARY OBSTRUCTION (BBO)

Aims To assess treatment outcomes of TEAs using transmural covered self-expandable metal-stents (cSEMS) to provide interval biliary drainage and to maintain access for staged biliary endotherapy under cholangioscopy or fluoroscopy in BBO not amenable to ERCP.

Methods Among 14,443 consecutive ERCPs databased over 15-years, 112 BBO patients (40.2% female; age=70.7 [SD 13.56] years) with EUS-guided transmural cSEMS were identified. Indications, technique, interventions, technical/clinical success, and AEs were retrieved.

Results Indications: Post-operative strictures 28.6%, CBD stones 23.2%, Non-surgical benign strictures 18.8%, Transections 15.2%, Hepatolithiasis 9.8%, Other 4.5%. Surgically-altered anatomy in 57.1% (Roux-en-Y gastrectomy 22%, Whipple 13.4%, Roux-en-Y hepatico-jejunostomy 11.6%, Other 8.9%). Primary EUS-BD in 37.5%; salvage EUS-BD following failed/incomplete ERCP in 62.5%. 8-10mm x 60-80mm cSEMS with anchoring flaps and/or anchoring clips/pigtails were used for transhepatic/extrahepatic (79%/21%) TEAs. Over a median (IQR) cSEMS indwell time of 118.5 (49-358) days a median (IQR) of 2 (1-3) treatment sessions guided by antegrade cholangiography/cholangioscopy through the cSEMS or naked fistula were performed for antegrade balloon-dilation, stent insertion/removal, stone removal±lithotripsy, rendezvous, magnetic compression anastomoses, needle-knife incision. cSEMS removal was successful in all attempted cases (66%); TEAs were converted to definitive transmural biliary drainage in 8.9%, 25.1% await treatment completion or have follow-up data unavailable. Final clinical success was achieved in 89.5% of patients. 37 AEs (5.4% severe) occurred in 213 procedures (17.4%).

Conclusions Select complex BBO patients can be treated using TEAs to provide drainage/access during staged endotherapy, thus precluding PTBD or surgery.

Publication History

Article published online:
14 April 2022