Endoscopic ultrasound guided biliary drainage in surgically altered anatomy: A comprehensive review of various approaches

Table 1 shows surgically altered anatomy, approach to biliary tree and endoscopic ultrasound guided biliary drainage procedures

No	Surgically altered anatomy	Approach to biliary tree	EUS biliary drainage procedure
1	Sleeve gastrectomy	From duodenum bile duct can be punctured; From Segment 2 or 3 ducts	Transmural: EUS CD, Rendezvous procedure; Transmural: EUS HGS, Antegrade drainage procedure
2	Billroth-I gastrectomy	From duodenum bile duct can be punctured; From segment 2 or 3 ducts	Transmural: EUS CD, Rendezvous procedure; Transmural: EUS HGS, Antegrade drainage procedure
3	Billroth-II gastrectomy	From segment 2 or 3 ducts	Transmural: EUS HGS, Antegrade drainage procedure
4	Roux-en-Y gastric bypass	From segment 2 or 3 ducts	Transmural: EUS HGS, Antegrade drainage procedure; EDGE procedure
5	Whipple’s procedure	From segment 2 or 3 ducts	Transmural: EUS HGS, Antegrade drainage procedure
6	Roux-en-Y hepatojejunostomy	From segment 2 or 3 ducts	Transmural: EUS HGS, Antegrade drainage procedure

CD: Choledochduodenostomy; HGS: Hepaticogastrostomy; EUS: Endoscopic ultrasound.

Table 2 Summarises current literature regarding technical and clinical success of different endoscopic ultrasound guided biliary drainage procedures in surgically altered anatomy

Serial No.	Ref.	EUS BD procedure	Surgically altered anatomy	Indication	No. of cases	Success rate (Technical and clinical)	Complications
1	Weilert et al[13], 2011	Antegrade approach	RY gastric bypass	Choledocholithiasis (CDL)	6	TS-67%; CS-NA	Liver hematoma- 1 case
2	Iwashita et al[14], 2013	Antegrade approach	RY gastrojejunostomy, Whipple’s	CDL, Malignant biliary obstruction (MBO)	6	TS-100%; CS-NA	Mild pancreatitis-2
3	Itoi et al[15], 2014	Antegrade approach	RY, Gastric bypass, Billroth reconstruction	CDL, MBO	5	TS-60%; CS-NA	Nil
4	Khashab et al[16], 2016	Antegrade approach	RY reconstruction, RYGB, Whipple, B-II	CDL, MBO	49	TS-98%; CS-88%	20%
5	Miranda-García et al[17], 2016	Antegrade approach	Biliary enteric anastomosis (details N/A)	Anastomotic stricture	7	TS-57%; CA-100%	70% Bleeding, stent migration
6	Iwashita et al[18], 2016	Antegrade approach	GR with RY-19; GR with BII-3; GR with jejunal interposition-2; PD-4; BDR with HJ-1	CDL	29	79%	17% Bile peritonitis, cholecystitis, elevated CRP
7	James et al[19], 2018	Antegrade approach	RYGB, RY, B-II reconstruction, Whipple	Benign biliary stricture	20	TS-95%; CS-95%	15% Abdominal pain, mild pancreatitis, mild cholangitis
8	Hosmer et al[20], 2018	Antegrade approach	RYGB, RY	CDL	9	TS-100%; CS-NA	11% Cholangitis
9	Mukai et al[21], 2019	Antegrade approach	RY, RYGB, Whipple, B-II	Benign biliary stricture, CDL	48	TS-91.9%; CS-91.9%	8.1% Biliary peritonitis
10	Huang et al[2], 2020	Transmural drainage; EUV RV-8; EUS-HG = 14; EUS-CD-11	Billroth I, Billroth II, RYGB, RYHJ Roux-en-Y choledochojejunostomy	MBO	33	TS-93.3%; CS-84.9%	9.09% Haemorrhage, cholangitis
11	Minaga et al[23], 2020	Transmural stenting -24; Antegrade stenting-2; Combination of transmural and antegrade-14	Gastrectomy with RY, Billroth-II, Pancreaticoduodenectomy, RYHJ	MBO	40	TS-100%; CS-95%	15% Bile leak, biliary peritonitis, pneumoperitoneum

CDL: Choledocholithiasis; CS: Clinical success; CRP: C Rectaive protein; EUS: Endoscopic ultrasound; MBO: Malignant biliary obstruction; RY: Roux-en-Y; RYGB: Roux-en-Y gastric bypass; RYHJ: Roux-en-Y hepaticojejunostomy; TS: Technical success.