Published online Mar 16, 2015. doi: 10.4253/wjge.v7.i3.283
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
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.
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.