Endoscopy 2019; 51(12): 1146-1150
DOI: 10.1055/a-0914-2855
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic entero-enteral bypass: an effective new approach to the treatment of postsurgical complications of hepaticojejunostomy

Authors

  • Massimiliano Mutignani

    1   Digestive and Interventional Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
  • Edoardo Forti

    1   Digestive and Interventional Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
  • Alberto Larghi

    2   Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
  • Francesco Pugliese

    1   Digestive and Interventional Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
  • Marcello Cintolo

    1   Digestive and Interventional Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
  • Mutaz Massad

    1   Digestive and Interventional Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
  • Angelo Italia

    1   Digestive and Interventional Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
  • Alberto Tringali

    1   Digestive and Interventional Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
  • Giovanni Carlo Ferrari

    3   Oncological and Mininvasive Surgery, Niguarda-Ca’ Granda Hospital, Milan, Italy
  • Andrea De Gasperi

    4   Department of Anaesthesia, Niguarda-Ca’ Granda Hospital, Milan, Italy
  • Antonio Rampoldi

    5   Interventional Radiology, Niguarda-Ca’ Granda Hospital, Milan, Italy
  • Luciano De Carlis

    6   Hepato-biliary-pancreatic Surgery and Liver Transplantation Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
  • Osvaldo Chiara

    7   Emergency and Trauma Center, Niguarda-Ca’ Granda Hospital, Milan, Italy
  • Carlo Paparozzi

    8   Department of Surgery and Translational Medicine, Careggi Hospital, Florence, Italy
  • Lorenzo Dioscoridi

    1   Digestive and Interventional Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
Weitere Informationen

Publikationsverlauf

submitted 24. Dezember 2018

accepted after revision 09. April 2019

Publikationsdatum:
04. Juni 2019 (online)

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Abstract

Background Management of biliary adverse events (BAEs) after biliodigestive anastomosis is challenging. We propose a new endoscopic approach to improve BAEs in this clinical setting.

Methods Patients who had BAEs after a hepaticojejunostomy with Roux-en-Y loop or a Whipple procedure underwent creation of an entero-enteral endoscopic bypass (EEEB) between the duodenal/gastric wall and the biliary jejunal loop under endoscopic ultrasound (EUS) and fluoroscopic guidance using specifically designed fully covered self-expandable metal stents.

Results 32 consecutive patients underwent EEEB, which was successful in all but one patient. One procedural and five long-term mild adverse events occurred. Endoscopic retrograde cholangiography (ERC) through the EEEB successfully treated all types of BAEs in these patients. Disease recurred in two patients who were successfully re-treated through the EEEB.

Conclusions Our retrospective study showed that in patients with BAEs after biliodigestive anastomosis, EEEB is safe, feasible, and allows a successful long-term treatment of different BAEs in a tertiary referral center with high-level experience in both endoscopic retrograde cholangiopancreatography and EUS.