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Endoscopic biliary access in patients with surgically altered anatomy：ERCP or EUS?
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Takuji Iwashita1,
Ichiro Yasuda2,
Masahito Shimizu1 |
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1First Department of Internal Medicine, Gifu University Hospital, 2Third Department of Internal Medicine, The University of Toyama Hospital |
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| The percutaneous approach has been used for the management of biliary disorders in patients with surgically altered anatomy (SAA) since the regular endoscope cannot reach the biliary orifice easily. However, the recent advancement in equipment and technique allowed us the endoscopic approach to the biliary system with two methods even in patients with SAA. Balloon assisted enteroscopy (BE) enabled to approach biliary orifice for ERCP. The original BE has major restrictions in device selection, because of its longer length and smaller diameter of the channel. The recent development of BE with a shorter length and a wider channel resolved most of the restrictions in device selections during BE-ERCP. The other approach method is EUS-guided biliary access, which includes EUS-guided transenteric biliary drainage (EBD) and antegrade approach (AG). In EUS-EBD, a stent was placed under EUS-guidance for biliary drainage between the intestine and the biliary system. As for EUS-AG, a fistula is created between the intestine and the biliary system and management of biliary disorders is performed through the fistula. Here, we want to report the current situation and future perspective of BE-ERCP and EUS-guided biliary access in patients with SAA. |
Index Term 1: EUS-guided biliary access
Index Term 2: enteroscopy assisted ERCP
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