Abstract
Background:
Biliary cannulation via balloon assisted-ERCP (BAE-ERCP) can be challenging. Patients with Roux-en-Y gastric bypass (RYGB) have amongst the lowest reported BAE-ERCP success rates when compared to other types of surgically altered anatomy. We explored the role of EUS-guided rendezvous (EUS-RV) as a rescue technique when BAE-ERCP fails.
Methods:
Consecutive patients with RYGB underwent BAE-ERCP for both benign and malignant indications. Amongst these, patient’s that failed BAE-ERCP despite the use of conventional advanced biliary cannulation techniques, underwent EUS-RV if the ampulla could be reached.
Results:
A total of 43 consecutive patients with RYGB underwent BAE-ERCP. The procedure was successful in 30 patients (69.7 %). Amongst the 13 patients with failed ERCP, EUS-RV was performed in 5 patients. Technical success was achieved in all 5 patients (100%), thereby increasing the overall BAE-ERCP success to 35 patients (81.3 %). There were no major procedure related adverse events on immediate and 3 month follow up. The average total procedure time for failed BAE-ERCP followed by EUS-RV, was 129 min (range 47 – 205 min)
Conclusion:
EUS-RV in patients with RYGB has high technical and clinical success and can be a viable alternative to more invasive options when BAE-ERCP fails using traditional cannulation techniques.