Background Management of biliary adverse events (BAEs) after biliodigestive anastomosis is challenging. We propose a new endoscopic approach to improve BAEs in this clinical setting. Methods Patients who had BAEs after a hepaticojejunostomy with Roux-en-Y loop or a Whipple procedure underwent creation of an entero-enteral endoscopic bypass (EEEB) between the duodenal/gastric wall and the biliary jejunal loop under endoscopic ultrasound (EUS) and fluoroscopic guidance using specifically designed fully covered self-expandable metal stents. Results 32 consecutive patients underwent EEEB, which was successful in all but one patient. One procedural and five long-term mild adverse events occurred. Endoscopic retrograde cholangiography (ERC) through the EEEB successfully treated all types of BAEs in these patients. Disease recurred in two patients who were successfully re-treated through the EEEB. Conclusions Our retrospective study showed that in patients with BAEs after biliodigestive anastomosis, EEEB is safe, feasible, and allows a successful long-term treatment of different BAEs in a tertiary referral center with high-level experience in both endoscopic retrograde cholangiopancreatography and EUS.

Mutignani, M., Forti, E., Larghi, A., Pugliese, F., Cintolo, M., Massad, M., et al. (2019). Endoscopic entero-enteral bypass: An effective new approach to the treatment of postsurgical complications of hepaticojejunostomy. ENDOSCOPY, 51(12), 1146-1150 [10.1055/a-0914-2855].

Endoscopic entero-enteral bypass: An effective new approach to the treatment of postsurgical complications of hepaticojejunostomy

Pugliese F.;De Carlis L.;Chiara O.;
2019

Abstract

Background Management of biliary adverse events (BAEs) after biliodigestive anastomosis is challenging. We propose a new endoscopic approach to improve BAEs in this clinical setting. Methods Patients who had BAEs after a hepaticojejunostomy with Roux-en-Y loop or a Whipple procedure underwent creation of an entero-enteral endoscopic bypass (EEEB) between the duodenal/gastric wall and the biliary jejunal loop under endoscopic ultrasound (EUS) and fluoroscopic guidance using specifically designed fully covered self-expandable metal stents. Results 32 consecutive patients underwent EEEB, which was successful in all but one patient. One procedural and five long-term mild adverse events occurred. Endoscopic retrograde cholangiography (ERC) through the EEEB successfully treated all types of BAEs in these patients. Disease recurred in two patients who were successfully re-treated through the EEEB. Conclusions Our retrospective study showed that in patients with BAEs after biliodigestive anastomosis, EEEB is safe, feasible, and allows a successful long-term treatment of different BAEs in a tertiary referral center with high-level experience in both endoscopic retrograde cholangiopancreatography and EUS.
Articolo in rivista - Articolo scientifico
Endoscopic bypass, enteral bypass, complications of hepaticojejunostomy, postsurgical complications
English
2019
51
12
1146
1150
none
Mutignani, M., Forti, E., Larghi, A., Pugliese, F., Cintolo, M., Massad, M., et al. (2019). Endoscopic entero-enteral bypass: An effective new approach to the treatment of postsurgical complications of hepaticojejunostomy. ENDOSCOPY, 51(12), 1146-1150 [10.1055/a-0914-2855].
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/275547
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