Role of the EUS in the Treatment of Biliopancreatic Disease in Patients with Surgically Altered Anatomy

Background: The rising prevalence of gastric, biliary, and pancreatic surgeries has led to an increasing population of patients with surgically altered anatomy (SAA). In this setting, conventional endoscopic retrograde cholangiopancreatography (ERCP) is often limited by anatomical barriers, resultin...

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Vydáno v:Diagnostics (Basel) Ročník 15; číslo 21; s. 2707
Hlavní autoři: Cintolo, Marcello, Forti, Edoardo, Bonato, Giulia, Puricelli, Michele, Dioscoridi, Lorenzo, Bravo, Marianna, Gallo, Camilla, Pugliese, Francesco, Palermo, Andrea, La Mantia, Alessia, Mutignani, Massimiliano
Médium: Journal Article
Jazyk:angličtina
Vydáno: Switzerland MDPI AG 26.10.2025
Témata:
Bile ducts
Biopsy
Calories
Care and treatment
Complications and side effects
Diagnosis
Diseases
EDGE
Endoscopy
EUS
Gastric cancer
Gastrointestinal surgery
Hepatectomy
Lesions
Liver transplants
Malnutrition
Metabolic disorders
Obesity
Pancreaticoduodenectomy
Patients
Small intestine
Stomach
Surgery
Surgery, Plastic
Surgical anastomosis
surgically altered anatomy
Tumors
Type 2 diabetes
Ultrasonic imaging
Weight control
surgically altered anatomy
EDGE
EUS
ISSN:2075-4418, 2075-4418
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Shrnutí:Background: The rising prevalence of gastric, biliary, and pancreatic surgeries has led to an increasing population of patients with surgically altered anatomy (SAA). In this setting, conventional endoscopic retrograde cholangiopancreatography (ERCP) is often limited by anatomical barriers, resulting in high rates of technical failure and complications. While device-assisted enteroscopy (DAE) has expanded therapeutic possibilities, its efficacy remains modest in complex reconstructions. Methods: This review analyzed recent literature from PubMed, Embase, and Scopus up to April 2025, focusing on diagnostic and therapeutic roles of endoscopic ultrasound (EUS) in SAA. Particular attention was given to cases where standard endoscopic, percutaneous, or surgical techniques failed and to studies comparing EUS-guided approaches with alternative modalities. Results: EUS has transitioned from a primarily diagnostic modality to a versatile therapeutic platform in SAA. Techniques such as EUS-guided rendezvous, antegrade drainage, and hepaticogastrostomy have shown technical and clinical success rates exceeding 80–90%, often comparable or superior to interventional radiology, while reducing the need for external drains. Innovative procedures, including EUS-directed transgastric ERCP (EDGE) and EUS-directed enteroenteric bypass (EDEE), have transformed the management of Roux-en-Y gastric bypass and bilioenteric anastomoses, providing durable and reusable access for repeated interventions. Despite these advances, EUS-guided interventions remain technically demanding, requiring advanced endoscopic and radiologic skills, specialized devices, and are best performed in tertiary referral centers. Conclusions: EUS has redefined the treatment paradigm of biliopancreatic diseases in patients with SAA, increasingly emerging as the preferred minimally invasive approach when conventional techniques fail. Future developments will focus on dedicated devices, standardized guidelines, and structured training programs to optimize outcomes. Multidisciplinary collaboration and centralization in high-volume centers remain essential to ensure safety, efficacy, and reproducibility.
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ISSN:2075-4418
2075-4418
DOI:10.3390/diagnostics15212707