There is an increasing number of patients with a history of both liver transplantation
(LT) and Roux-en-Y gastric bypass (RYGB). Biliary tract complications are the most
prevalent LT-associated complication, with endoscopic retrograde cholangiopancreatography
(ERCP) as the preferred therapeutic approach. However, surgically altered anatomy
after RYGB renders ERCP technically challenging. We performed an overview of endoscopic
treatment modalities of biliary tract complications in LT recipients with a history
of RYGB. Different techniques are discussed and illustrated with clinical cases.
Balloon enteroscopy-assisted-ERCP (BE-ERCP), endoscopic ultrasound (EUS)-directed
trans gastric endoscopic retrograde cholangiopancreatography (EDGE), percutaneous
trans hepatic biliary drainage (PTBD), or a combination of these procedures can be
used according to the clinical indication or the surgical reconstruction of the bile
duct. Case 1 was treated with PTBD, followed by BE-ERCP; case 2 was treated with BE-ERCP,
followed by EDGE; case 3 was treated with PTBD, followed by EDGE; and case 4 was treated
with BE-ERCP [1]
[2]
[3]
[4]
[5]
[6]
[7].
The management of LT-associated biliary tract complications in patients with RYGB
anatomy poses a significant challenge and prompts a multidisciplinary discussion for
deciding the optimal strategy. Next to PTBD, both BE-ERCP and EDGE have emerged as
promising endoscopic therapeutic methods for this indication, owing to their established
safety and efficacy in various other clinical contexts. More studies focusing on this
specific population are warranted to comprehensively assess the efficacy and safety
profiles of these procedures.
