Endoscopic ultrasound–directed transenteric endoscopic retrograde cholangiopancreatography for biliary interventions in altered anatomy: tips and techniques

Q3 Medicine

VideoGIE Pub Date : 2026-10-01 Epub Date: 2026-05-06 DOI:10.1016/j.vgie.2026.04.045

Michael Lajin MD, Kevin Bui MD, Tyler Jackson MD, Michael Khanjyan MD

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引用次数: 0

Abstract

Background and Aims

Traditionally, deep enteroscopy, surgery, or percutaneous biliary drains were used to gain access for biliary interventions in patients with Roux-en-Y reconstruction. These methods are cumbersome, less successful than standard ERCP, and carry a higher risk of adverse events (AEs). Transductal and transmural EUS-assisted techniques are increasingly used in these settings. Although EUS-directed transgastric ERCP is mainly used for Roux-en-Y gastric bypass, EUS-directed transenteric ERCP (EDEE) is used for Roux-en-Y hepaticojejunostomy (RYHJ) and Roux-en-Y gastrectomy.

Methods

In this case series, we presented 3 patients who underwent EDEE for stones, strictures, or both. We highlighted the technical differences between RYHJ and Roux-en-Y gastrectomy, as well as the different methods to distend the targeted small-bowel loop.

Results

The biliary orifice was easily reached, and biliary interventions were successfully performed in all patients using the necessary accessories. There were no AEs directly related to the procedures.

Conclusions

EDEE is an important technique for biliary interventions in patients with nongastric bypass Roux-en-Y reconstruction. Further data are needed to assess its long-term effectiveness and safety.

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内镜下超声引导经肠内镜逆行胆管造影在改变解剖中的胆道干预：提示和技术

背景和目的传统上，对于Roux-en-Y重建患者，通常采用深肠镜检查、手术或经皮胆道引流来获得胆道干预。这些方法繁琐，不如标准ERCP成功，并且具有更高的不良事件（ae）风险。转导和跨壁eus辅助技术越来越多地用于这些情况。虽然EUS-directed经胃ERCP主要用于Roux-en-Y胃旁路术，但EUS-directed经肠ERCP （EDEE）也用于Roux-en-Y肝空肠吻合术（RYHJ）和Roux-en-Y胃切除术。方法在本病例系列中，我们报告了3例因结石、狭窄或两者兼有而行EDEE的患者。我们强调了RYHJ和Roux-en-Y胃切除术之间的技术差异，以及扩张目标小肠袢的不同方法。结果所有患者均能顺利到达胆道口，并使用必要的辅助器具进行胆道干预。没有与手术直接相关的不良反应。结论sedee是非胃旁路Roux-en-Y重建患者胆道干预的重要技术。需要进一步的数据来评估其长期有效性和安全性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

VideoGIE Medicine-Gastroenterology

CiteScore

1.50

自引率

0.00%

发文量

132

审稿时长

105 days

期刊介绍： VideoGIE, an official video journal of the American Society for Gastrointestinal Endoscopy, is an Open Access, online-only journal to serve patients with digestive diseases. VideoGIE publishes original, single-blinded peer-reviewed video case reports and case series of endoscopic procedures used in the study, diagnosis, and treatment of digestive diseases. Videos demonstrate use of endoscopic systems, devices, and techniques; report outcomes of endoscopic interventions; and educate physicians and patients about gastrointestinal endoscopy. VideoGIE serves the educational needs of endoscopists in training as well as advanced endoscopists, endoscopy staff and industry, and patients. VideoGIE brings video commentaries from experts, legends, committees, and leadership of the society. Careful adherence to submission guidelines will avoid unnecessary delays, as incomplete submissions may be returned to the authors before initiation of the peer review process.