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01-12-2021 | Billroth II Resection

Endoscopic and percutaneous biliary interventions in patients with altered upper gastrointestinal anatomy—the Munich Multicenter Experience

Authors: Simon Nennstiel, Kathrin Freivogel, Alexander Faber, Christoph Schlag, Bernhard Haller, Martin Blöchinger, Markus Dollhopf, Björn Lewerenz, Wolfgang Schepp, Jörg Schirra, Roland M. Schmid, Bruno Neu

Published in: Surgical Endoscopy | Issue 12/2021

Abstract

Background

In patients with altered upper gastrointestinal anatomy, conventional endoscopic retrograde cholangiography is often not possible and different techniques, like enteroscopy-assisted or percutaneous approaches are required. Aim of this study was to analyze success and complication rates of these techniques in a large collective of patients in the daily clinical practice in a pre-endosonographic biliary drainage era.

Patients and methods

Patients with altered upper gastrointestinal anatomy with biliary interventions between March 1st, 2006, and June 30th, 2014 in four tertiary endoscopic centers in Munich, Germany were retrospectively analyzed.

Results

At least one endoscopic-assisted biliary intervention was successful in 234/411 patients (56.9%)—in 192 patients in the first, in 34 patients in the second and in 8 patients in the third attempt. Success rates for Billroth-II/Whipple-/Roux-en-Y reconstruction were 70.5%/56.7%/49.5%. Complication rates for these reconstructions were 9.3%/6.5%/6.3%, the overall complication rate was 7.1%. Success rates were highest in patients with Billroth-II reconstruction where use of a duodenoscope was possible, complication rates were also highest in this scenario. Success rates were lowest in longer-limb anatomy like Roux-en-Y reconstruction. Percutaneous biliary drainages (PTBD) were inserted 268 times with substantially higher success (90.7%) as well as complication rates (11.6%) compared to the endoscopic approach. Compared to patients treated endoscopically, patients with PTBD had a lower performance status, more severe cholestasis and a significant higher rate of malignant underlying disease.

Conclusion

In patients with altered upper gastrointestinal anatomy, success rates of endoscopic-assisted biliary interventions are lower compared to PTBD. Still, due to the beneficial complication rates of the endoscopic approach, this technique should be preferred whenever possible and in selected patients who still need to be defined in detail, repeated endoscopic attempts are useful to help achieve the desired result.

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Title: Endoscopic and percutaneous biliary interventions in patients with altered upper gastrointestinal anatomy—the Munich Multicenter Experience
Authors: Simon Nennstiel
Kathrin Freivogel
Alexander Faber
Christoph Schlag
Bernhard Haller
Martin Blöchinger
Markus Dollhopf
Björn Lewerenz
Wolfgang Schepp
Jörg Schirra
Roland M. Schmid
Bruno Neu
Publication date: 01-12-2021
Publisher: Springer US
Keywords: Billroth II Resection
Billroth II Resection
Endoscopic Retrograde Cholangiopancreatography
Published in: Surgical Endoscopy / Issue 12/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-020-08191-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Endoscopic and percutaneous biliary interventions in patients with altered upper gastrointestinal anatomy—the Munich Multicenter Experience

Abstract

Background

Patients and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Patients and methods

Results

Conclusion

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