{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T11:35:49Z","timestamp":1790249749210,"version":"4.1.0"},"reference-count":50,"publisher":"Georg Thieme Verlag KG","issue":"09","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Z Gastroenterol"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n               Background and study aim Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for the treatment of biliary obstruction of any etiology. However, cannulation failure of the common bile duct (CBD) by ERCP occurs in 5\u201310%. Alternatives after a failed ERCP are re-ERCP by an expert endoscopist, percutaneous transhepatic cholangio drainage (PTCD), (balloon) enteroscopy-assisted ERCP, or surgery. Endoscopic ultrasonography-guided drainage of the bile ducts (EUS-BD) is becoming the standard of care in tertiary referral centers for cases of failed ERCP in patients with malignant obstruction of the CBD. In expert hands, EUS-guided biliary drainage has excellent technical\/clinical success rates and lower complication rates compared to PTCD. Despite the successful performance of EUS-BD in malignant cases, its use in benign cases is limited. <\/jats:p><jats:p>The aim of this study (design, systematic prospective clinical observational study on quality assurance in daily clinical practice) was to evaluate the efficacy and safety of EUS-BD in benign indications.<\/jats:p><jats:p>\n               Patients and methods Patients with cholestasis and failed ERCP were recruited from a prospective EUS-BD registry (2004\u20132020). One hundred and three patients with EUS-BD and benign cholestasis were extracted from the registry (nTotal = 474). Indications of EUS-BDs included surgically altered anatomy (n = 65), atypical bile duct percutaneous transhepatic cholangio orifice at the duodenal junction from the longitudinal to the horizontal segment (n = 1), papilla of Vater not reached due to the gastric outlet\/duodenal stenoses (n = 6), papilla that cannot be catheterized (n = 24), and proximal bile duct stenosis (n = 7). The primary endpoint was technical and clinical success. Secondary endpoints were procedure-related complications during the hospital stay.<\/jats:p><jats:p>\n               Results 103 patients with EUS-BD and benign cholestasis were extracted from the registry (nTotal=474). Different transluminal access routes were used to reach the bile ducts: transgastric (n = 72\/103); -duodenal (n = 16\/103); -jejunal (n = 14\/103); combined -duodenal and -gastric (n = 1\/103). The technical success rate was 96 % (n = 99) for cholangiography. Drainage was not required in 2 patients; balloon dilatation including stone extraction was sufficient in 17 cases (16.5 %; no additional or prophylactic insertion of a drain). Transluminal drainage was achieved in n = 68\/103 (66 %; even higher in patients with drain indication only) by placement of a plastic stent (n = 29), conventional biliary metal stents (n = 24), HotAXIOS stents (n = 5; Boston Scientific, Ratingen, Germany), Hanaro stents (n = 6; Olympus, Hamburg, Germany), HotAXIOS stents and plastic stents (n = 1), HotAXIOS stents and metal stents (n = 1) and metal stents and plastic stents (n = 2). Techniques for stone extraction alone (nSuccessful=17) or stent insertion (nTotal = 85; nSuccessful=85 \u2013 rate, 100 %) and final EUS-BD access pathway included: Rendezvous technique (n = 14\/85; 16.5 %), antegrade internal drainage (n = 20\/85; 23.5 %), choledochointestinostomy (n = 7\/85; 8.2 %), antegrade internal and hepaticointestinostomy (n = 22\/85; 25.9 %), hepaticointestinostomy (n = 21\/85; 24.7 %), choledochointestinostomy and hepaticointestinostomy (n = 1\/85; 1.2 %).<\/jats:p><jats:p>The complication rate was 25 % (n = 26) \u2013 the spectrum comprised stent dislocation (n = 11), perforation (n = 1), pain (n = 2), hemorrhage (n = 6), biliary ascites\/leakage (n = 3) and bilioma\/liver abscess (n = 3; major complication rate, n = 12\/68 \u2013 17.6 %). Re-interventions were required in 19 patients (24 interventions in total).<\/jats:p><jats:p>\n               Discussion EUS-BD can be considered an elegant and safe alternative to PTCD or reoperation for failed ERCP to achieve the necessary drainage of the biliary system even in underlying benign diseases. An interventional EUS-based internal procedure can resolve cholestasis, avoid PTCD or reoperation, and thus improve quality of life. Due to the often complex (pathological and\/or postoperative) anatomy, EUS-BD should only be performed in centers with interventional endoscopy\/EUS experience including adequate abdominal surgery and interventional radiology expertise in the background. This enables adequately adapted therapeutic management in the event of challenging complications. It seems appropriate to conduct further studies with larger numbers of cases to systematize the approach and peri-interventional management and to successively develop specific equipment.<\/jats:p>","DOI":"10.1055\/a-1540-7975","type":"journal-article","created":{"date-parts":[[2021,9,10]],"date-time":"2021-09-10T23:00:45Z","timestamp":1631314845000},"page":"933-943","source":"Crossref","is-referenced-by-count":8,"title":["EUS-guided biliary interventions for benign diseases and unsuccessful ERCP \u2013 a prospective unicenter feasibility study on a large consecutive patient cohort"],"prefix":"10.1055","volume":"59","author":[{"given":"Frank","family":"F\u00fcldner","sequence":"additional","affiliation":[{"name":"Dept. of Internal Medicine II (Gastroenterology, Hepatology and General Internal Medicine), Municipal Hospital (\u201cSRH Wald-Klinikum Gera GmbH\u201d) of Gera, Gera, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Meyer","sequence":"additional","affiliation":[{"name":"Dept. of General, Abdominal, Vascular and Transplant Surgery, Otto-von-Guericke University Medical School with University Hospital, Magdeburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uwe","family":"Will","sequence":"additional","affiliation":[{"name":"Dept. of Internal Medicine II (Gastroenterology, Hepatology and General Internal Medicine), Municipal Hospital (\u201cSRH Wald-Klinikum Gera GmbH\u201d) of Gera, Gera, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2021,9,10]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1608","DOI":"10.1002\/lt.20623","article-title":"A case of successful enteroscopic balloon dilation for late anastomotic stricture of choledochojejunostomy after living donor liver transplantation","volume":"11","author":"H Haruta","year":"2005","journal-title":"Liver Transpl"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1007\/s12328-014-0505-3","article-title":"Endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy using balloon-assisted enteroscope","volume":"7","author":"A Katanuma","year":"2014","journal-title":"Clin J Gastroenterol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1055\/s-2007-1004077","article-title":"Endoscopic access to the papilla of Vater for endoscopic retrograde cholangiopancreatography in patients with Billroth II or Roux-en-Y gastrojejunostomy","volume":"29","author":"RE Hintze","year":"1997","journal-title":"Endoscopy"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1016\/s0016-5107(02)70182-x","article-title":"ERCP in patients with long limb Roux-en-Y gastrojejunostomy and intact papilla","volume":"56","author":"BE Wright","year":"2002","journal-title":"Gastrointest Endosc"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1241","DOI":"10.1055\/s-2006-945003","article-title":"Endoscopic retrograde cholangiopancreatography in post-Whipple patients","volume":"38","author":"P Chahal","year":"2006","journal-title":"Endoscopy"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1016\/j.ejrad.2007.01.032","article-title":"Percutaneous treatment of benign bile duct strictures","volume":"62","author":"M K\u00f6cher","year":"2007","journal-title":"Eur J Radiol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1055\/s-2001-14264","article-title":"Long-term follow-up of percutaneous transhepatic therapy (PTT) in patients with definite benign anastomotic strictures after hepaticojejunostomy","volume":"33","author":"B Schumacher","year":"2001","journal-title":"Endoscopy"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1007\/s13244-011-0119-y","article-title":"Two decades of percutaneous transjejunal biliary intervention for benign biliary disease: a review of the intervention nature and complications","volume":"2","author":"D Fontein","year":"2011","journal-title":"Insights Imaging"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1007\/s002619910032","article-title":"Percutaneous balloon dilatation for benign hepaticojejunostomy strictures","volume":"25","author":"PM Vos","year":"2000","journal-title":"Abdom Imaging"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1055\/s-0029-1214507","article-title":"Long-term follow-up of percutaneous transhepatic biliary drainage (PTBD) in patients with benign bilioenterostomy stricture","volume":"41","author":"A Weber","year":"2009","journal-title":"Endoscopy"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1016\/0002-9610(84)90054-0","article-title":"Recurrent biliary stricture. 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