Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Mar 16, 2015; 7(3): 283-289
Published online Mar 16, 2015. doi: 10.4253/wjge.v7.i3.283
Endoscopic ultrasound-guided biliary intervention in patients with surgically altered anatomy
Aroon Siripun, Pimsiri Sripongpun, Bancha Ovartlarnporn
Aroon Siripun, Bancha Ovartlarnporn, NKC Institute of Gastroenterology and Hepatology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
Pimsiri Sripongpun, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
Author contributions: Siripun A and Sripongpun P performed the literature search and wrote the first draft of the paper; Ovartlanporn B reviewed and edited the article.
Conflict-of-interest: Siripun A, Sripongpun P and Ovartlarnporn B have no conflict of interest to declare.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Bancha Ovartlarnporn, MD, NKC Institute of Gastroenterology and Hepatology, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Rd., Hat Yai, Songkhla 90110, Thailand. mrovart@ji-net.com
Telephone: +66-81-7664879 Fax: +66-74-429436
Received: August 27, 2014
Peer-review started: August 31, 2014
First decision: November 27, 2014
Revised: January 8, 2015
Accepted: February 4, 2015
Article in press: February 9, 2015
Published online: March 16, 2015
Processing time: 204 Days and 15.4 Hours
Abstract

AIM: To evaluate the efficacy of endoscopic ultrasound guided biliary drainage (EUS-BD) in patients with surgically altered anatomies.

METHODS: We performed a search of the MEDLINE database for studies published between 2001 to July 2014 reporting on EUS-BD in patients with surgically altered anatomy using the terms “EUS drainage” and “altered anatomy”. All relevant articles were accessed in full text. A manual search of the reference lists of relevant retrieved articles was also performed. Only full-text English papers were included. Data regarding age, gender, diagnosis, method of EUS-BD and intervention, type of altered anatomy, technical success, clinical success, and complications were extracted and collected. Anatomic alterations were categorized as: group 1, Billroth I; group 2, Billroth II; group 4, Roux-en-Y with gastric bypass; and group 3, all other types.

RESULTS: Twenty three articles identified in the literature search, three reports were from the same group with different numbers of cases. In total, 101 cases of EUS-BD in patients with altered anatomy were identified. Twenty-seven cases had no information and were excluded. Seventy four cases were included for analysis. Data of EUS-BD in patients categorized as group 1, 2 and 4 were limited with 2, 3 and 6 cases with EUS-BD done respectively. Thirty four cases with EUS-BD were reported in group 3. The pooled technical success, clinical success, and complication rates of all reports with available data were 89.18%, 91.07% and 17.5%, respectively. The results are similar to the reported outcomes of EUS-BD in general, however, with limited data of EUS-BD in patients with altered anatomy rendered it difficult to draw a firm conclusion.

CONCLUSION: EUS-BD may be an option for patients with altered anatomy after a failed endoscopic-retrograde-cholangiography in centers with expertise in EUS-BD procedures in a research setting.

Keywords: Endoscopic ultrasound-guided anterograde approach; Endoscopic ultrasound-guided biliary drainage; Endoscopic ultrasound-guided choledochoduodenostomy; Endoscopic ultrasound-guided hepaticogastrostomy; Endoscopic ultrasound-rendezvous technique; Surgically altered anatomy; Overtube-assisted enteroscopy-endoscopic retrograde cholangiopancreatography

Core tip: Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy is challenging, with a failure rate as high as 26%. Data of endoscopic ultrasound-guided biliary drainage (EUS-BD) in patients with altered anatomy from the literature show a similar efficacy to that of EUS-BD in general. EUS-BD may be selected as an alternative for patients with altered anatomy who failed overtube-assisted enteroscopy-ERCP in centers where the expertise in EUS-BD is available. However, the EUS-BD approach should be performed in a research setting based on the current stage of EUS-BD techniques.