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Year : 2021  |  Volume : 10  |  Issue : 1  |  Page : 33-38

EUS-guided transanastomotic drainage for severe biliopancreatic anastomotic stricture using a forward-viewing echoendoscope in patients with surgically altered anatomy

1 Department of Gastroenterology, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
2 Department of Gastroenterology, JCHO Sagamino Hospital, Sagamihara, Kanagawa, Japan

Correspondence Address:
Dr. Tomohisa Iwai
Department of Gastroenterology, Kitasato University Hospital, 1-15-1 Kitasato, Minami, Sagamihara, 252-0374, Kanagawa
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/eus.eus_72_20

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Background and Objectives: Balloon enteroscopy-assisted ERCP (BE-ERCP) has become the first-line therapy for biliopancreatic anastomotic strictures. However, it is not always successful, and salvage methods have not been established. This study aimed to evaluate the outcomes of EUS-guided transanastomotic drainage using a forward-viewing (FV) echoendoscope. Patients and Methods: Of eight cases wherein BE-ERCP treatment failed due to severe or complete benign anastomotic stricture, seven cases underwent EUS-guided choledochojejunostomy, and EUS-guided pancreaticojejunostomy was applied in one case after intubating an FV echoendoscope into the anastomotic site. Results: The success rate of reaching the target site was 100% (8/8) for patients after modified Child resection. The median time to reach the anastomosis was 5 min (range: 3–17 min), and the technical success rate for drainage was 75% (6/8). The median total procedure time was 33.5 min (range: 22–45 min) for six successful cases. Cautery dilatation catheters were necessary to dilate the puncture site in all cases, and no early complications were observed. During the follow-up period (median: 13.3 months [range: 6.5–60.3]), recurrence of the stricture occurred in one case, and a stent-free status was achieved after 6–12 months of stent placement in five cases. Conclusions: EUS-guided transanastomotic drainage using an FV echoendoscope is a feasible and safe rescue technique for the management of benign severe biliopancreatic anastomotic strictures.

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