Transenteric ERCP via EUS-guided anastomosis using lumen-apposing metal stents in patients with surgically altered anatomy (with video) - 01/12/25

Doi : 10.1016/j.gie.2025.10.005

Enrique Pérez-Cuadrado-Robles, MD, PhD ^1,^2,^⁎ , Michiel Bronswijk, MD ^3,⁴, Amy Tyberg, MD ⁵, Giuseppe Vanella, MD, PhD ⁶, Andrea Anderloni, MD ^7,⁸, Pieter Hindryckx, MD, PhD ⁹, Haroon Shahid, MD ⁵, Paolo Giorgio Arcidiacono, MD ^6,¹⁰, Jean-Philippe Ratone, MD ¹¹, Avik Sarkar, MD ⁵, Cecilia Binda, MD ¹², Iman Andalib, MD ⁵, Wim Laleman, MD, PhD ^3,¹³, Jan-Werner Poley, MD ¹⁴, Mariano Gonzalez Haba, MD ¹⁵, Fabrice Caillol, MD ¹¹, Carlo Fabbri, MD ¹², Tom Boeken, MD ^2,¹⁶, Aymeric Becq, MD, PhD ¹⁷, Laurent Monino, MD ¹⁸, Christophe Cellier, MD, PhD ^1,², Michel Kahaleh, MD ¹⁹, Schalk van der Merwe, MD, PhD ³

¹ Department of Gastroenterology, Georges-Pompidou European Hospital, APHP.Centre, Paris, France

² University of Paris-Cité, Paris, France

³ Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium

⁴ Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden, Belgium

⁵ Hackensack Meridian Health Care System, Hackensack, New Jersey, USA

⁶ Pancreatobiliary Endoscopy and Endosonography Division, San Raffaele Scientific Institute, Milan, Italy

⁷ Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy

⁸ Gastroenterology and Digestive Endoscopy Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy

⁹ Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium

¹⁰ Vita Salute San Raffaele University, Milan, Italy

¹¹ Digestive Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France

¹² Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy

¹³ Medizinische Klinik B, Universitätsklinikum Münster, Munster, Germany

¹⁴ Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, Netherlands

¹⁵ Department of Gastroenterology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain

¹⁶ Department of Interventional Radiology, Georges-Pompidou European Hospital, APHP.Centre, Paris, France

¹⁷ Department of Gastroenterology, Henri Mondor Hospital, Creteil, France

¹⁸ Department of Gastroenterology, University Hospital of Montpellier, Montpellier, France

¹⁹ Foundation for Interventional & Therapeutic Endoscopy, New Brunswick, New Jersey, USA

^∗ Corresponding author: Enrique Pérez-Cuadrado-Robles, MD, PhD, Department of Gastroenterology, Georges-Pompidou European Hospital, 20 Rue Leblanc, Paris 75015, France. Department of Gastroenterology Georges-Pompidou European Hospital 20 Rue Leblanc Paris 75015 France

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Monday 01 December 2025

Abstract

Background and Aims

Endoscopic ultrasonography (EUS)-directed transenteric endoscopic retrograde cholangiopancreatography (ERCP, EUS-directed transenteric ERCP [EDEE]) using a lumen-apposing metal stent (LAMS) is a novel biliary drainage technique for patients with surgically altered anatomy. The study aimed to evaluate the feasibility, safety, and effectiveness of EDEE.

Methods

This is a multicenter, retrospective study. We included consecutive patients with altered anatomy who underwent an EDEE. Surgical anatomy configuration, prior biliary drainage, and ERCP indications were collected. The EUS-guided anastomosis technique was assessed. The primary outcome was the technical success of the EDEE. The secondary outcomes were the clinical success and the adverse events (AEs).

Results

Ninety-four ERCPs were performed in 55 patients (60 ± 16.2 years old, 56.4% male). The most frequent surgical anatomy was Roux-en-Y hepaticojejunostomy ( n = 23, 41.8%) and a prior biliary drainage was performed in 28 patients (50.9%). Benign strictures were the most frequent indication (58.2%). The most frequent techniques to identify the biliary limb were EUS imaging alone ( n = 14, 25.5%) and EUS-guided puncture of the biliary limb with retrograde opacification of the surgical hepaticojejunostomy ( n = 14, 25.5%). The procedure was performed using a direct freehand approach ( n = 49, 89.1%). Technical and clinical success rates of EDEE were 87.3% and 93.8%, respectively. The overall AE rate was 20% (9.1% LAMS-related). The rate of persistent fistula was 30.6% with a median follow-up period of 3 months.

Conclusions

The EDEE technique offers a new and effective approach for biliary drainage in patients with surgically altered anatomy, particularly in benign indications and/or when several ERCPs are expected.

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Abbreviations : AE, EDEE, EDGE, ERCP, EUS, HJ, LAMS, RYGB, SAA