PDF icon PDF herunterladen
Open Access
CC BY-NC-ND 4.0 · Endosc Int Open 2025; 13: a25097500
DOI: 10.1055/a-2509-7500
Innovation forum

EUS-guided rendezvous is a viable salvage technique for failed billiary cannulation in patients with Roux-en-Y gastric bypass undergoing BAE-ERCP

Kambiz Kadkhodayan 
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Sagar Pathak
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Saurabh Chandan
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Abdullah Abassi
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Artur Viana
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Maham Hayat
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Mustafa A Arain
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Natalie Cosgrove
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Deepanshu Jain
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Dennis Yang
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Muhammad Khalid Hasan
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Shayan Irani
2   Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, United States (Ringgold ID: RIN7289)
› Institutsangaben
› Weitere Informationen
Auch verfügbar aufeRef
  Lizenzen und Reprints
Preview

Abstract

Background and study aims

Biliary cannulation via balloon-assisted-ERCP (BAE-ERCP) can be challenging. Patients with Roux-en-Y gastric bypass (RYGB) have among the lowest reported BAE-ERCP success rates when compared with other types of surgically altered anatomy. We explored the role of EUS-guided rendezvous (EUS-RV) as a rescue technique when BAE-ERCP fails.

Patients and methods

Consecutive patients with RYGB underwent BAE-ERCP for both benign and malignant indications. Among them, patients in whom BAE-ERCP failed despite use of conventional advanced biliary cannulation techniques underwent EUS-RV if the ampulla could be reached.

Results

Forty-three consecutive patients with RYGB underwent BAE-ERCP. The procedure was successful in 30 patients (69.7%). Among the 13 patients with failed ERCP, EUS-RV was performed in five. Technical success was achieved in all five patients (100%), thereby increasing the overall BAE-ERCP success to 35 patients (81.3%). There were no major procedure-related adverse events on immediate and 3-month follow-up. Average total procedure time for failed BAE-ERCP followed by EUS-RV was 129 minutes (range 47–205 minutes).

Conclusions

EUS-RV in patients with RYGB has high technical and clinical success and can be a viable alternative to more invasive options when BAE-ERCP fails using traditional cannulation techniques.

Keywords

Pancreatobiliary (ERCP/PTCD) - ERC topics - Endoscopic ultrasonography - Biliary tract - Intervention EUS


Publikationsverlauf

Eingereicht: 10. Oktober 2024

Angenommen nach Revision: 16. Dezember 2024

Accepted Manuscript online:
02. Januar 2025

Artikel online veröffentlicht:
05. Februar 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Kambiz Kadkhodayan, Sagar Pathak, Saurabh Chandan, Abdullah Abassi, Artur Viana, Maham Hayat, Mustafa A Arain, Natalie Cosgrove, Deepanshu Jain, Dennis Yang, Muhammad Khalid Hasan, Shayan Irani. EUS-guided rendezvous is a viable salvage technique for failed billiary cannulation in patients with Roux-en-Y gastric bypass undergoing BAE-ERCP. Endosc Int Open 2025; 13: a25097500.
DOI: 10.1055/a-2509-7500
 

  • References

  • 1 Ward ZJ, Bleich SN, Cradock AL. et al. Projected U.S. state-level prevalence of adult obesity and severe obesity. N Engl J Med 2019; 381: 2440-2450
    Suche in Google Scholar
  • 2 Belgau I, Johnsen G, Græslie H. et al. Frequency of cholelithiasis in need of surgical or endoscopic treatment a decade or more after Roux-en-Y gastric bypass. Surg Endosc 2023; 37: 1349-1356
    Suche in Google Scholar
  • 3 Ghazi R, Razzak FA, Kerbage A. et al. Endoscopic retrograde cholangiopancreatography (ERCP) approach for patients with Roux-en-Y gastric bypass: a comparative study between four ERCP techniques with proposed management algorithm. Surg Obes Relat Dis 2024; 20: 53-61
    Suche in Google Scholar
  • 4 Shah RJ, Smolkin M, Yen R. et al. A multicenter, U.S. experience of single-balloon, double-balloon, and rotational overtube-assisted enteroscopy ERCP in patients with surgically altered pancreaticobiliary anatomy (with video). Gastrointest Endosc 2013; 77: 593-600
    Suche in Google Scholar
  • 5 Gopakumar H, Singh RR, Revanur V. et al. Endoscopic ultrasound-guided vs endoscopic retrograde cholangiopancreatography-guided biliary drainage as primary approach to malignant distal biliary obstruction: A\a systematic review and meta-analysis of randomized controlled trials. Am J Gastroenterol 2024; 119: 1607-1615
    Suche in Google Scholar
  • 6 Choudhury A, Samanta J, Muktesh G. et al. Endoscopic ultrasound-guided rendezvous technique versus precut sphincterotomy as salvage technique in patients with benign biliary disease and difficult biliary cannulation: A randomized controlled trial. Ann Intern Med 2024; 177: 1361-1369
    Suche in Google Scholar
  • 7 Nass KJ, Zwager LW, van der Vlugt M. et al. Novel classification for adverse events in GI endoscopy: the AGREE classification. Gastrointest Endosc 2022; 95: 1078-1085 e8
    Suche in Google Scholar
  • 8 Kedia P, Sharaiha RZ, Kumta NA. et al. Internal EUS-directed transgastric ERCP (EDGE): game over. Gastroenterology 2014; 147: 566-568
    Suche in Google Scholar
  • 9 Kedia P, Shah-Khan S, Tyberg A. et al. Endoscopic ultrasound-directed transgastric ERCP (EDGE): A multicenter US study on long-term follow-up and fistula closure. Endosc Int Open 2023; 11: E529-e37
    Suche in Google Scholar
  • 10 da Ponte-Neto AM, Bernardo WM, de A Coutinho LM. et al. Comparison between enteroscopy-based and laparoscopy-assisted ERCP for Accessing the biliary tree in patients with roux-en-y gastric bypass: Systematic review and meta-analysis. Obes Surg 2018; 28: 4064-4076
    Suche in Google Scholar