Kapil Jamwal1, Manoj Kumar Sharma2, Barjesh Chander Sharma2, Shiv Kumar Sarin2. 1. Center for Liver and Digestive Diseases, Dharamshila Narayana Hospital, Dallupura, New Delhi, 110 096, India. drkapil222@gmail.com. 2. Departments of Hepatology and Advanced Endoscopy, Institute of Liver and Biliary Sciences, D-1, Acharya Shree Tulsi Marg, Vasant Kunj, New Delhi, 110 070, India.
Abstract
INTRODUCTION: With the advances in imaging and endoscopic technology, scope of endoscopic interventions in biliary obstruction associated with altered gastrointestinal (GI) anatomy has increased. We analyzed our experience on single-balloon enteroscopy and endoscopic ultrasound (EUS)-guided ERCP (SBE-ERCP) and EUS-guided hepatogastrostomy (EUS-HG) in the presence of altered GI anatomy. METHODS: Data of 15 patients (SBE-ERCP in 12, and EUS-HG in 3) over a period of 1 year (April 2016-March 2017) and followed up for 90 to 270 days were retrospectively analyzed. Inclusion criteria were (a) age 18-80 years, (b) fit for anesthesia, (c) intact primary confluence, (d) failed percutaneous transhepatic biliary drainage (PTBD) or difficult EUS-HG (due to poor visualization of intrahepatic ducts due to pneumobilia after PTBD; SBE-ERCP was undertaken in them), and (e) cholangitis without shock. Exclusion criteria were (a) involved or separated primary biliary confluence, (b) shock, (c) unfit for anesthesia, and (d) liver metastasis in the left lobe (EUS-HG). RESULTS: All were symptomatic with pain, jaundice, and cholangitis. The median serum bilirubin and serum alkaline phosphatase (SAP) were 2.8 mg/dL and 273 IU/mL, respectively. SBE-ERCP in 12 and EUS-HG in 3 cases were done successfully with observed success rate of 91.6% and 100% (3/3), respectively. Three patients had minor complications (post-procedure pain, fever, and pneumoperitoneum), which were managed conservatively. CONCLUSION: Endoscopic interventions in patients with altered GI anatomy are safe.
INTRODUCTION: With the advances in imaging and endoscopic technology, scope of endoscopic interventions in biliary obstruction associated with altered gastrointestinal (GI) anatomy has increased. We analyzed our experience on single-balloon enteroscopy and endoscopic ultrasound (EUS)-guided ERCP (SBE-ERCP) and EUS-guided hepatogastrostomy (EUS-HG) in the presence of altered GI anatomy. METHODS: Data of 15 patients (SBE-ERCP in 12, and EUS-HG in 3) over a period of 1 year (April 2016-March 2017) and followed up for 90 to 270 days were retrospectively analyzed. Inclusion criteria were (a) age 18-80 years, (b) fit for anesthesia, (c) intact primary confluence, (d) failed percutaneous transhepatic biliary drainage (PTBD) or difficult EUS-HG (due to poor visualization of intrahepatic ducts due to pneumobilia after PTBD; SBE-ERCP was undertaken in them), and (e) cholangitis without shock. Exclusion criteria were (a) involved or separated primary biliary confluence, (b) shock, (c) unfit for anesthesia, and (d) liver metastasis in the left lobe (EUS-HG). RESULTS: All were symptomatic with pain, jaundice, and cholangitis. The median serum bilirubin and serum alkaline phosphatase (SAP) were 2.8 mg/dL and 273 IU/mL, respectively. SBE-ERCP in 12 and EUS-HG in 3 cases were done successfully with observed success rate of 91.6% and 100% (3/3), respectively. Three patients had minor complications (post-procedure pain, fever, and pneumoperitoneum), which were managed conservatively. CONCLUSION: Endoscopic interventions in patients with altered GI anatomy are safe.
Entities:
Keywords:
Cholangitis; Hepaticojejunostomy; Roux-en-Y surgery
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