ENDOSCOPIC TRANSLUMINAL PROCEDURES VIA EUS-GUIDED ANASTOMOSIS

Abstract

The use of interventional EUS, referred to as IV-EUS procedures is increasing in high-volume centers in the failed/difficult cases for performing ERCP related procedures. As EUS-guided drainage/anastomosis (EUS-D/A) is not only for drainage, but also aids in the creation of anastomosis, endoscopic treatments through EUS-guided anastomosis are available. EUS-guided antegrade procedures (EUS-AG) and transluminal procedures through the EUS-anastomosis are mainly performed for cases with surgically altered anatomy, biliary/pancreatic stones, and stenosis. Endoscopic necrosectomy for walled-off necrosis after severe pancreatitis is classified in this procedure as well. These procedures are less invasive than percutaneous procedures, and the patient quality of life is better; however, the procedure has not been established because there are still a few dedicated devices. In our institution, the management of biliary/pancreatic stones and stricture with per-oral cholangioscopy and pancreatoscopy through the EUS-anastomosis are mainly performed. In this article, the tips and considerations for the techniques through EUS-anastomosis of the biliary and pancreatic duct are explained.