Endoscopic Recanalization of Hepaticojejunostomy Using Percutaneous Rendez-vous Technique and EUS-Guided Transenteric ERCP

Le résumé fourni par la source

Introduction: Double-balloon enteroscopy-assisted ERCP (DBE-ERCP) is utilized in patients with surgically altered anatomy, achieving a 75% success rate. Complete occlusion of bilioenteric anastomoses is rare and complex, with repeat surgery carrying significant risks. Alternatively, EUS-guided transenteric ERCP (EDEE) creates a shortcut to the biliary tree using a lumen-apposing metal stent (LAMS), simplifying access and allowing standard ERCP procedures. Case presentation: Patient a 31-year-old female, with a history of cholecystectomy and iatrogenic bile duct injury, initially received a percutaneous transhepatic catheter. She developed stenosis of a hepaticojejunostomy (Roux-en-Y), losing communication with the left hepatic duct. Imaging confirmed complete occlusion, and a combined approach of DBE-ERCP and laser cholangioscopy achieved recanalization at the CMN in Mexico City. DBE-ERCP identified a narrow hepaticojejunostomy. A percutaneous cholangioscope confirmed complete duct closure, which was recanalized using laser ablation. Given the need for further interventions, EUS-guided gastroenteric access was performed, and a LAMS was deployed under fluoroscopic and endoscopic guidance, allowing for effective biliary rehabilitation. Discussion and conclusion: DBE-ERCP and EDEE are effective approaches for treating complex biliary complications in patients with altered anatomy. EDEE is a promising addition to biliary access techniques, although it remains technically challenging with potential risks. Technique refinement and prospective studies are needed to better define its role in this patient population [ 1 ] [ 2 ] [ 3 ]. Publication History Article published online: 27 March 2025 © 2025. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.