Endoscopic biliary drainage in patients with surgically-altered anatomy: the street multicenter study

Aurelio Mauro; Giuseppe Vanella; Vincenzo Giorgio Mirante; Alessandro Fugazza; Cecilia Binda; Luca Elli; Edoardo Forti; Roberto Di Mitri; Debora Berretti; Helga Bertani; Mariangela Delliponti; Federico Desideri; Virginia Ferretti; Roberto Grassia; Roberto Leone; Mauro Manno; Stefano Mazza; Alessandro Mussetto; Tommaso Pessarelli; Giacomo Emanuele Maria Rizzo; Marco Spadaccini; Ilaria Tarantino; Carlo Fabbri; Andrea Anderloni; i-EUS group

doi:10.1016/j.gie.2025.04.032

Endoscopic biliary drainage in patients with surgically-altered anatomy: the street multicenter study

Gastrointest Endosc. 2025 Apr 25:S0016-5107(25)01625-6. doi: 10.1016/j.gie.2025.04.032. Online ahead of print.

Collaborators

i-EUS group:
Michele Amata, Paolo Giorgio Arcidiacono, Paolo Cantù, Silvia Cocca, Luca De Luca, Giulia Gambini, Andrea Lisotti, Ignazio Marzio Parisi, Andrea Parodi, Massimiliano Mutignani, Alessandro Repici, Romano Sassatelli, Davide Scalvini, Paola Soriani, Edoardo Troncone, Giovanna Venezia

PMID: 40288693
DOI: 10.1016/j.gie.2025.04.032

Abstract

Background and study aims: Endoscopic biliary drainage (BD) in patients with surgical altered anatomy (SAA) is a challenging scenario. Different BD approaches are available but still not standardized and that rely on local availability and expertise. Aim of this study was to explore the approach to BD in patients with SAA in different centers.

Patients and methods: This was a retrospective multicenter cohort study: All adult patients with SAA who underwent endoscopic BD for any indication in the last 5 years were enrolled. Clinical outcomes were evaluated according to the type of surgical reconstruction, the clinical indication and the type of endoscopic BD technique.

Results: 432 patients were included. Global technical and clinal success of BD was 80.3% and 79.9% respectively. Outcomes were similar among the different types of surgical reconstruction except for a higher rate of adverse events in patients with Billroth-II reconstruction (14.4%). BD approach in patients with Roux-en-Y reconstruction was heterogeneous with a higher use of more advanced procedures such as DAE-ERCP and interventional EUS. Interventional EUS procedures were more frequently performed in the last two-year period showing a higher probability of clinical success (OR=7.87, 95%CI: 2.56-24.13, p<0.001) than the other BD techniques with lower rate of reintervention in the follow-up period.

Conclusions: BD in patients with SAA is still associated with suboptimal chance of success in all the different types of reconstruction. The increasing use of interventional EUS procedures in the last years significantly improved outcomes in patients with SAA treated with these techniques.