Management of Biliary Emergencies in Patients with Surgically Altered Anatomy

Abstract

In this study, we attempted to evaluate the differences in the outcomes of management of biliary emergencies in patients with surgically altered anatomy. The subjects of the study were 55 cases of biliary emergencies managed between 2021 and 2022. The evaluated parameters included the endoscopic reach rate, bile duct cannulation rate, procedure completion rate, and complications. The median age of the patients was 74 years. The reconstruction techniques included SSPPD (30 cases), B-II (9 cases), R-Y (9 cases), and hepaticojejunostomy (9 cases). The outcomes of balloon enteroscopy-assisted ERCP (BE-ERCP) were as follows: endoscopic reach rate, 89.5%; biliary cannulation rate, 98%; and procedure completion rate, 90%. Complications included perforation (2 cases), intestinal mucosal tear (3 cases), cholecystitis (1 case), cholangitis (1 case), pancreatitis (1 case), liver abscess (1 case), and esophageal variceal rupture (1 case). Secondary treatments included repeat BE-ERCP (2 cases), interventional (IV)-EUS (3 cases), percutaneous transhepatic biliary drainage (PTBD) (4 cases), and conservative treatment (2 cases). Combining BE-ERCP, IV-EUS, and PTBD may potentially achieve a higher completion rate of conservative management.