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EUS-guided tans-anastomotic drainage for severe choledochojejunal anastomotic stricture in patients with surgically altered anatomy
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Tomohisa Iwai1,
Junro Ishizaki1,
Chika Kusano1 |
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1Department of Gastroenterology, Kitasato University Hospital |
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| Biliopancreatic anastomotic stricture is one of the most popular and problematic adverse events in patients with surgically altered anatomy. Balloon enteroscopy-assisted ERCP has been established as a first-line treatment for anastomotic stricture, but severe or complete stenosis is challenging and sometimes requires percutaneous transhepatic biliary drainage (PTBD) or rendezvous technique when it fails. Blind puncture from the intestinal tract is uncertain and dangerous because large vessels often exist at the anastomotic site. EUS-guided choledochojejunostomy (CJS) performed since 2015 in our institution was studied retrospectively. It was applied in 12 cases after intubating a forward- viewing echoendoscope into the anastomotic site. The success rate of reaching the target site was 100% (12/12) for patients after modified Child resection. The median time to reach the anastomosis was 5 min [3-17], and the technical success rate was 83% (10/12). The median total procedure time was 44min [22-84] for 10 successful cases and two cases of failure were treated with PTBD. One cholangitis with bacteremia was observed as an early complication. Stent-free status was achieved after 6 to 12 months of stent placement in all six cases that were attempted, and recurrence happened in one case. EUS-CJS is considered safe and useful as a salvage technique for severe anastomotic stricture. The indications for EUS-CJS, and tips for the puncture site, dilatation, and stent placement will be shown in the presentation. |
Index Term 1: anastomotic stricture
Index Term 2: EUS-guided choledochojejunostomy
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