Endoscopic ultrasound-guided antegrade treatment of bile duct stone in patients with surgically altered anatomy: a multicenter retrospective cohort study

• Published in: Journal of hepato-biliary-pancreatic sciences 2016-04, Vol.23 (4), p.227-233
• Main Authors: Iwashita, Takuji, Nakai, Yousuke, Hara, Kazuo, Isayama, Hiroyuki, Itoi, Takao, Park, Do Hyun
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Antegrade; Bile; Bile duct stone; Bile Ducts - diagnostic imaging; Bile Ducts - surgery; Endoscopic papillary balloon dilation; Endoscopic ultrasound; Endoscopy; Feasibility Studies; Female; Follow-Up Studies; Gallstones - diagnosis; Gallstones - surgery; Humans; Male; Retrospective Studies; Surgery, Computer-Assisted - methods; Surgically altered anatomy; Ultrasonic imaging; Ultrasonography, Interventional - methods
• ISSN: 1868-6974; 1868-6982
• DOI: 10.1002/jhbp.329

Background Endoscopic retrograde cholangiopancreatography (ERCP) for management of bile duct stone (BDS) in patients with surgically altered anatomy is challenging even when applying enteroscopy. Endoscopic ultrasound‐guided antegrade treatments (EUS‐AG) for BDS have been developed but have not been well studied yet. The aim of the present study was to evaluate the feasibility and safety of EUS‐AG for BDS in patients with surgically altered anatomy as a multicenter retrospective cohort study. Methods A retrospective database analysis was performed to identify patients with surgically altered anatomy who underwent EUS‐AG for the management of BDS at four academic care centers. Basic characteristics of the patients and details of the procedures were determined and the success rates and adverse event rates were evaluated. Results EUS‐AG for BDS was attempted in 29 patients. Successful BDS removal was achieved in 72% (21/29) of patients. Reasons for failed EUS‐AG were unsuccessful bile duct puncture in six, unsuccessful guidewire manipulation in one, and unsuccessful stone removal using a retrieval balloon in one. Adverse events occurred in five (17%) but were successfully managed conservatively. Conclusion EUS‐AG for BDS is a feasible and safe alternative in patients with surgically altered anatomy, although further evaluation and development of dedicated devices are needed. Highlight In this multicenter retrospective cohort study, Iwashita and colleagues show that endoscopic ultrasound‐guided antegrade treatment for bile duct stones is a feasible and safe alternative to endoscopic retrograde cholangiopancreatography in patients with surgically altered upper gastrointestinal or biliary tract anatomy.