Challenges of Endoscopic Management of Pancreaticobiliary Complications in Surgically Altered Gastrointestinal Anatomy
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Pancreaticobiliary complications following various surgical procedures, including liver transplantation, are not uncommon and areimportant causes of morbidity and mortality. Therapeutic endoscopy plays a substantial role in these patients and can help to avoid theneed for reoperation. However, the endoscopic approach in patients with surgically altered gastrointestinal (GI) anatomy is technicallychallenging because of the diffculty in entering the enteral limb to reach the target orifice to manage pancreaticobiliary complications. Additional procedural complexity is due to the need of special devices and accessories to obtain successful cannulation and absenceof an elevator in forward-viewing endoscopes, which is frequently used in this situation. Once bilioenteric anastomosis is reached, thetechnical success rates achieved in expert hands approach those of patients with intact GI anatomy. The success of endoscopic therapyin patients with surgically altered GI anatomy depends on multiple factors, including the expertise of the endoscopist, understandingof postoperative anatomic changes, and the availability of suitable scopes and accessories for endoscopic management. In this issueof Clinical Endoscopy, the focused review series deals with pancreatobiliary endoscopy in altered GI anatomy such as bilioentericanastomosis and post-gastrectomy.
Abstract
Pancreaticobiliary complications following various surgical procedures, including liver transplantation, are not uncommon and areimportant causes of morbidity and mortality. Therapeutic endoscopy plays a substantial role in these patients and can help to avoid theneed for reoperation. However, the endoscopic approach in patients with surgically altered gastrointestinal (GI) anatomy is technicallychallenging because of the diffculty in entering the enteral limb to reach the target orifice to manage pancreaticobiliary complications. Additional procedural complexity is due to the need of special devices and accessories to obtain successful cannulation and absenceof an elevator in forward-viewing endoscopes, which is frequently used in this situation. Once bilioenteric anastomosis is reached, thetechnical success rates achieved in expert hands approach those of patients with intact GI anatomy. The success of endoscopic therapyin patients with surgically altered GI anatomy depends on multiple factors, including the expertise of the endoscopist, understandingof postoperative anatomic changes, and the availability of suitable scopes and accessories for endoscopic management. In this issueof Clinical Endoscopy, the focused review series deals with pancreatobiliary endoscopy in altered GI anatomy such as bilioentericanastomosis and post-gastrectomy.
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