Chalikonda Divya, Mitsuhashi Shuji, Shinn Brianna, Tyberg Amy, Shahid Haroon, Sarkar Avik, Kahaleh Michel, Khara Harshit S, Confer Bradley, Kamal Faisal, Chiang Austin, Schlachterman Alexander, Kumar Anand, Loren David, Kowalski Thomas
Division of Gastroenterology, Thomas Jefferson University Hospital, 132 South 10th Street, Main Building, Suite 480, Philadelphia, PA, 19107, USA.
Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Dig Dis Sci. 2025 Aug 19. doi: 10.1007/s10620-025-09297-0.
Biliary access in patients with Roux-en-Y hepaticojejunostomy, pancreaticoduodenectomy and duodenal switch can be challenging. Placement of an EUS guided lumen apposing metal stent (LAMS) between the small bowel and the afferent jejunal limb can create an entero-enteric conduit (EUS-EE), allowing for successful endoscopic access to the biliary tree for intervention. In this study, we aim to describe the safety and efficacy of EUS-EE for biliary access.
This is a multicenter retrospective cohort study of patients who underwent EUS-EE for the purpose of biliary intervention at three US centers. The primary outcome was technical success. Secondary outcomes included clinical success, defined as ability to perform intended biliary intervention and adverse events. Descriptive statistics were used to analyze the data.
Eighteen patients underwent EUS-EE for biliary access. The most common surgical anatomy was a Roux-en-Y hepaticojejunostomy (66.6%). 72.2% of patients had either deep enteroscopy or a hepaticogastrostomy attempted for biliary access prior to proceeding with EUS-EE placement. A 20 mm LAMS was used in 12 patients and 15 mm used in 6 patients. Technical and clinical success was achieved in 100% of patients. Two adverse events were noted; 1 patient had a perforation of the opposite jejunal wall that was treated with through-the-scope clips and one patient had minor bleeding that was managed conservatively.
This study demonstrates the feasibility, safety, and efficacy of EUS-EE for management of biliary disorders in patients with surgically altered anatomy. Future large scale multicenter studies are needed to further validate these findings.
在接受 Roux-en-Y 肝空肠吻合术、胰十二指肠切除术和十二指肠转位术的患者中，建立胆道通路可能具有挑战性。在小肠和输入空肠袢之间放置超声内镜引导下的腔内对吻金属支架（LAMS）可创建肠-肠通道（EUS-EE），从而成功实现内镜进入胆道系统进行干预。在本研究中，我们旨在描述 EUS-EE 用于胆道通路的安全性和有效性。
这是一项多中心回顾性队列研究，研究对象为在美国三个中心接受 EUS-EE 以进行胆道干预的患者。主要结局为技术成功。次要结局包括临床成功，定义为能够进行预期的胆道干预以及不良事件。采用描述性统计分析数据。
18 例患者接受 EUS-EE 以建立胆道通路。最常见的手术解剖结构是 Roux-en-Y 肝空肠吻合术（66.6%）。72.2%的患者在进行 EUS-EE 放置之前曾尝试通过深度肠镜检查或肝胃吻合术进行胆道通路建立。12 例患者使用了 20mm 的 LAMS，6 例患者使用了 15mm 的 LAMS。所有患者均实现了技术和临床成功。记录到两例不良事件；1 例患者对侧空肠壁穿孔，通过内镜夹进行了治疗，1 例患者出现轻微出血，采取了保守治疗。
本研究证明了 EUS-EE 用于治疗解剖结构改变患者的胆道疾病的可行性、安全性和有效性。未来需要进行大规模多中心研究以进一步验证这些发现。
