{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T12:03:05Z","timestamp":1789387385741,"version":"build-2803163510"},"reference-count":93,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Endoscopic retrograde cholangiopancreatography (ERCP) remains the reference standard for biliary drainage, yet it fails in up to 15% of cases, most notably when a surgically altered anatomy (SAA) is present. The expanding use of bariatric and oncologic gastrointestinal surgery has increased the number of patients in whom the papilla is displaced, unreachable, or replaced by a biliodigestive anastomosis, making conventional access difficult or impossible. This narrative review appraises the current evidence on endoscopic biliary drainage in SAA, focusing on procedural efficacy, anatomical peculiarities, adverse-event profiles and technical considerations to guide clinical decision-making. Available strategies include luminal techniques, duodenoscope-assisted ERCP, forward-viewing (cap-assisted colonoscope) ERCP, and enteroscope-assisted ERCP, as well as endoscopic ultrasound-guided biliary drainage (EUS-BD), encompassing EUS-guided hepaticogastrostomy, EUS-guided antegrade stenting, EUS-guided rendezvous and EUS-directed transgastric\/transenteric ERCP (EDGE\/EDEE), and laparoscopic-assisted ERCP (LA-ERCP). No single approach is universally superior and available comparative data is mainly retrospective and affected by major selection bias. Technique selection should be tailored to the reconstruction type, indication (benign vs. malignant), limb length, expected survival, and local expertise, ideally within a multidisciplinary, high-volume setting. Adequately powered randomized trials incorporating quality-of-life and cost-effectiveness endpoints are still needed to define the optimal first-line strategy. This literature review encompasses the multiple strategies to achieve biliary drainage in surgically altered anatomy, highlighting strengths and weaknesses of each technique, as well as the preferred approach for each type of anatomical reconstruction.<\/jats:p>","DOI":"10.3390\/medicina62091766","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T10:19:41Z","timestamp":1789381181000},"page":"1766","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Current Evidence on Endoscopic Biliary Drainage in the Era of Surgically Altered Anatomy: A Narrative Review"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-7051-5432","authenticated-orcid":false,"given":"Davide","family":"Scalvini","sequence":"first","affiliation":[{"name":"Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia,  Italy"},{"name":"Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Ciccioli","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, ASST Rhodense, Rho Hospital, 20017 Rho, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0895-1225","authenticated-orcid":false,"given":"Angelo","family":"Bruni","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy"},{"name":"Gastroenterology Unit, IRCCS Policlinico di Sant\u2019Orsola, Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2201-6279","authenticated-orcid":false,"given":"Marco","family":"Valvano","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, E.O. Ospedali Galliera, 16128 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianmaria","family":"La Rosa","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia,  Italy"},{"name":"Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4737-9401","authenticated-orcid":false,"given":"Michele","family":"Dota","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, ASL Novara, 28100 Novara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Cappellini","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia,  Italy"},{"name":"Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulio","family":"Massetti","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia,  Italy"},{"name":"Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guglielmo","family":"Aprile","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia,  Italy"},{"name":"Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Torello Viera","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5710-4658","authenticated-orcid":false,"given":"Letizia","family":"Veronese","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3440-4981","authenticated-orcid":false,"given":"Gianluca","family":"Franchellucci","sequence":"additional","affiliation":[{"name":"Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9068-3209","authenticated-orcid":false,"given":"Stefano","family":"Mazza","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8475-5464","authenticated-orcid":false,"given":"Aurelio","family":"Mauro","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Bardone","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0485-4903","authenticated-orcid":false,"given":"Alessandro","family":"Fugazza","sequence":"additional","affiliation":[{"name":"Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3909-9012","authenticated-orcid":false,"given":"Marco","family":"Spadaccini","sequence":"additional","affiliation":[{"name":"Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy"},{"name":"Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1621-6450","authenticated-orcid":false,"given":"Alessandro","family":"Repici","sequence":"additional","affiliation":[{"name":"Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy"},{"name":"Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1021-0031","authenticated-orcid":false,"given":"Andrea","family":"Anderloni","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia,  Italy"},{"name":"Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1055\/a-0862-0346","article-title":"Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline","volume":"51","author":"Manes","year":"2019","journal-title":"Endoscopy"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"6207","DOI":"10.1007\/s00464-024-11245-4","article-title":"Biliary drainage in patients with malignant distal biliary obstruction: Results of an Italian consensus conference","volume":"38","author":"Marzioni","year":"2024","journal-title":"Surg. Endosc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1055\/s-0034-1391231","article-title":"Prospective evaluation of ERCP performance: Results of a nationwide quality registry","volume":"47","author":"Ekkelenkamp","year":"2015","journal-title":"Endoscopy"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Han, S., Kolb, J.M., Edmundowicz, S.A., Attwell, A.R., Hammad, H.T., Wani, S., and Shah, R.J. (2025). The Success and Safety of Endoscopic Retrograde Cholangiopancreatography in Surgically Altered Gastrointestinal Anatomy. Med. Sci., 13.","DOI":"10.3390\/medsci13010018"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1067\/mge.2001.120169","article-title":"Endoscopy and ERCP in the setting of previous upper GI tract surgery. Part I: Reconstruction without alteration of pancreaticobiliary anatomy","volume":"54","author":"Feitoza","year":"2001","journal-title":"Gastrointest. Endosc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1067\/mge.2002.120385","article-title":"Endoscopy and ERCP in the setting of previous upper GI tract surgery. Part II: Postsurgical anatomy with alteration of the pancreaticobiliary tree","volume":"55","author":"Feitoza","year":"2002","journal-title":"Gastrointest. Endosc."},{"key":"ref_7","doi-asserted-by":"crossref","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":"Hintze","year":"1997","journal-title":"Endoscopy"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1246","DOI":"10.1055\/s-2006-944970","article-title":"Endoscopic retrograde cholangiopancreatography after pancreaticoduodenectomy for benign and malignant disease: Indications and technical outcomes","volume":"38","author":"Farrell","year":"2006","journal-title":"Endoscopy"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1136\/gut.25.9.971","article-title":"ERCP and sphincterotomy after Billroth II gastrectomy","volume":"25","author":"Forbes","year":"1984","journal-title":"Gut"},{"key":"ref_10","first-page":"155","article-title":"Diagnostic and therapeutic ERCP in patients with Billroth II gastrectomy","volume":"57","author":"Costamagna","year":"1994","journal-title":"Acta Gastroenterol. Belg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.gie.2025.04.032","article-title":"Endoscopic biliary drainage in patients with surgically altered anatomy: The Street multicenter study","volume":"103","author":"Mauro","year":"2026","journal-title":"Gastrointest. Endosc."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Mauro, A., Binda, C., Fugazza, A., Vanella, G., Mirante, V.G., Mazza, S., Scalvini, D., Tarantino, I., Fabbri, C., and Anderloni, A. (2024). On Behalf of The I-Eus Group. Italian Survey on Endoscopic Biliary Drainage Approach in Patients with Surgically Altered Anatomy. Medicina, 60.","DOI":"10.3390\/medicina60030472"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"7269","DOI":"10.1007\/s00464-024-11329-1","article-title":"A retrospective comparative study of biliary drainage using balloon endoscopy and endoscopic ultrasound for malignant obstruction in patients with surgically altered anatomy","volume":"38","author":"Hakuta","year":"2024","journal-title":"Surg. Endosc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1016\/j.gie.2018.04.2353","article-title":"EUS-guided hepaticoenterostomy as a portal to allow definitive antegrade treatment of benign biliary diseases in patients with surgically altered anatomy","volume":"88","author":"James","year":"2018","journal-title":"Gastrointest. Endosc."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1756284820930964","DOI":"10.1177\/1756284820930964","article-title":"Endoscopic ultrasound-guided biliary drainage for malignant biliary obstruction with surgically altered anatomy: A multicenter prospective registration study","volume":"13","author":"Minaga","year":"2020","journal-title":"Ther. Adv. Gastroenterol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1016\/j.gie.2025.10.005","article-title":"Transenteric endoscopic retrograde cholangiopancreatography via endoscopic ultrasound-guided anastomosis using lumen-apposing metal stents in patients with surgically altered anatomy (with video)","volume":"103","author":"Bronswijk","year":"2026","journal-title":"Gastrointest. Endosc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1055\/s-0034-1391567","article-title":"ERCP in patients with prior Billroth II gastrectomy: Report of 30 years\u2019 experience","volume":"47","author":"Bove","year":"2015","journal-title":"Endoscopy"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1055\/s-0029-1215108","article-title":"Effective \u201cshort\u201d double-balloon enteroscope for diagnostic and therapeutic ERCP in patients with altered gastrointestinal anatomy: A large case series","volume":"41","author":"Shimatani","year":"2009","journal-title":"Endoscopy"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"de Carvalho Bertaccini Guriam, G., Pornchai, A., Dutra, L.P., de Araujo, E., and Sousa, A.M. (2026). Forward-viewing endoscopy with cap-fitting versus side-viewing duodenoscope for ERCP in Billroth II gastrectomy: A systematic review and meta-analysis. Gastrointest. Endosc., S0016-5107(26)06770-2.","DOI":"10.1055\/s-0046-1821136"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1016\/j.gie.2017.10.044","article-title":"Multicenter evaluation of the clinical utility of laparoscopy-assisted ERCP in patients with Roux-en-Y gastric bypass","volume":"87","author":"Abbas","year":"2018","journal-title":"Gastrointest. Endosc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"6853","DOI":"10.1007\/s00464-020-08191-2","article-title":"Endoscopic and percutaneous biliary interventions in patients with altered upper gastrointestinal anatomy-the Munich Multicenter Experience","volume":"35","author":"Nennstiel","year":"2021","journal-title":"Surg. Endosc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1002\/jhbp.823","article-title":"Endoscopic ultrasound guided-antegrade biliary stenting vs percutaneous transhepatic biliary stenting for unresectable distal malignant biliary obstruction in patients with surgically altered anatomy","volume":"27","author":"Iwashita","year":"2020","journal-title":"J. Hepatobiliary Pancreat. Sci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3365","DOI":"10.1007\/s00464-021-08653-1","article-title":"EUS-guided biliary drainage with electrocautery-enhanced lumen-apposing metal stent placement should replace PTBD after ERCP failure in patients with distal tumoral biliary obstruction: A large real-life study","volume":"36","author":"Ginestet","year":"2022","journal-title":"Surg. Endosc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1053\/j.gastro.2023.07.024","article-title":"Endoscopic Ultrasound-Guided Biliary Drainage of First Intent with a Lumen-Apposing Metal Stent vs Endoscopic Retrograde Cholangiopancreatography in Malignant Distal Biliary Obstruction: A Multicenter Randomized Controlled Study (ELEMENT Trial)","volume":"165","author":"Chen","year":"2023","journal-title":"Gastroenterology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1053\/j.gastro.2025.09.003","article-title":"Endoscopic Ultrasound-Guided Choledochoduodenostomy vs Endoscopic Retrograde Cholangiopancreatography in Malignant Distal Biliary Obstruction to Prevent Postprocedural Pancreatitis: A Randomized Trial","volume":"170","author":"Anderloni","year":"2026","journal-title":"Gastroenterology"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Martinelli, V., Singh, S., Politi, P., Caccialanza, R., Peri, A., Pietrabissa, A., and Chiappedi, M. (2023). Ethics of Bariatric Surgery in Adolescence and Its Implications for Clinical Practice. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20021232"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1016\/j.giec.2024.06.005","article-title":"Bariatric Surgery: Current Trends and Newer Surgeries","volume":"34","author":"Smolkin","year":"2024","journal-title":"Gastrointest. Endosc. Clin. N. Am."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"zraf007","DOI":"10.1093\/bjsopen\/zraf007","article-title":"Relationship between pancreatic cancer resection rate and survival at population level: Systematic review","volume":"9","author":"Lockie","year":"2025","journal-title":"BJS Open"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Mazza, S., Masciangelo, G., Mauro, A., Scalvini, D., Torello Viera, F., Bardone, M., Veronese, L., Rovedatti, L., Agazzi, S., and Strada, E. (2024). Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction: A Comprehensive Review on Technical Tips and Clinical Outcomes. Diagnostics, 14.","DOI":"10.3390\/diagnostics14232644"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Mauro, A., Crisciotti, C., Massetti, G., Alfieri, D., Mazza, S., Scalvini, D., Cappellini, A., Aprile, G., La Rosa, G., and Viera, F.T. (2026). Therapeutic Endoscopic Ultrasound in Biliopancreatic Disease. J. Clin. Med., 15.","DOI":"10.3390\/jcm15082848"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1097\/eus.0000000000000130","article-title":"EUS-guided hepaticogastrostomy versus single balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography for malignant biliary obstruction in patients with surgically altered anatomy","volume":"14","author":"Shibuki","year":"2025","journal-title":"Endosc. Ultrasound"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"ASGE Standards of Practice Committee, Pawa, S., Marya, N.B., Thiruvengadam, N.R., Ngamruengphong, S., Baron, T.H., Bun Teoh, A.Y., Bent, C.K., Abidi, W., and Alipour, O. (2024). American Society for Gastrointestinal Endoscopy guideline on the role of therapeutic EUS in the management of biliary tract disorders: Summary and recommendations. Gastrointest. Endosc., 100, 967\u2013979.","DOI":"10.1016\/j.gie.2024.03.027"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1055\/a-1717-1391","article-title":"Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline","volume":"54","author":"Bronswijk","year":"2022","journal-title":"Endoscopy"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"122","DOI":"10.4253\/wjge.v15.i3.122","article-title":"Endoscopic ultrasound guided biliary drainage in surgically altered anatomy: A comprehensive review of various approaches","volume":"15","author":"Sundaram","year":"2023","journal-title":"World J. Gastrointest. Endosc."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2194","DOI":"10.1007\/s11695-023-06602-6","article-title":"Comparison of Efficacy and Safety Between Roux-en-Y Gastric Bypass (RYGB) vs One Anastomosis Gastric Bypass (OAGB) vs Single Anastomosis Duodeno-ileal Bypass with Sleeve Gastrectomy (SADI-S): A Systematic Review of Bariatric and Metabolic Surgery","volume":"33","author":"Balamurugan","year":"2023","journal-title":"Obes. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"S19","DOI":"10.1055\/s-2003-41532","article-title":"Techniques of selective cannulation and sphincterotomy","volume":"35","author":"Maydeo","year":"2003","journal-title":"Endoscopy"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"3091","DOI":"10.3748\/wjg.v25.i24.3091","article-title":"Recent advances in endoscopic retrograde cholangiopancreatography in Billroth II gastrectomy patients: A systematic review","volume":"25","author":"Park","year":"2019","journal-title":"World J. Gastroenterol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"355","DOI":"10.4103\/sjg.SJG_118_19","article-title":"Endoscopic retrograde cholangiopancreatography in Billroth II gastrectomy patients: Outcomes and potential factors affecting technical failure","volume":"25","author":"Li","year":"2019","journal-title":"Saudi J. Gastroenterol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1016\/j.vgie.2020.08.003","article-title":"Use of a rigidizing overtube for altered-anatomy ERCP","volume":"5","author":"Wei","year":"2020","journal-title":"VideoGIE"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1111\/den.13022","article-title":"Endoscopic management of bile duct stones in patients with surgically altered anatomy","volume":"30","author":"Nakai","year":"2018","journal-title":"Dig. Endosc."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"109","DOI":"10.5009\/gnl13447","article-title":"Feasibility of cap-assisted endoscopic retrograde cholangiopancreatography in patients with altered gastrointestinal anatomy","volume":"9","author":"Ki","year":"2015","journal-title":"Gut Liver"},{"key":"ref_42","first-page":"267","article-title":"Side-Viewing Duodenoscope versus Forward-Viewing Gastroscope for Endoscopic Retrograde Cholangiopancreatography in Billroth II Gastrectomy Patients","volume":"30","author":"Chaves","year":"2022","journal-title":"GE Port. J. Gastroenterol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"390","DOI":"10.3892\/etm.2024.12679","article-title":"Endoscopic retrograde cholangiopancreatography using a pediatric colonoscope in patients with Roux-en-Y gastrectomy and an intact major duodenal papilla","volume":"28","author":"Wang","year":"2024","journal-title":"Exp. Ther. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1055\/a-1311-9779","article-title":"Underwater cap-assisted endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy: A pilot study","volume":"53","author":"Fugazza","year":"2021","journal-title":"Endoscopy"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1055\/a-1964-2100","article-title":"Motorized spiral enteroscopy-assisted ERCP in surgically altered anatomy: Early experience from a retrospective cohort study","volume":"55","author":"Schneider","year":"2023","journal-title":"Endoscopy"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"E1417","DOI":"10.1055\/a-0754-2290","article-title":"Usefulness of the \u201cnewly designed\u201d short-type single-balloon enteroscope for ERCP in patients with Roux-en-Y gastrectomy: A pilot study","volume":"6","author":"Tanisaka","year":"2018","journal-title":"Endosc. Int. Open"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1159\/000177017","article-title":"ERCP with the balloon-assisted enteroscopy technique: A systematic review","volume":"26","author":"Koornstra","year":"2008","journal-title":"Dig. Dis."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"111022","DOI":"10.3748\/wjg.v31.i41.111022","article-title":"Comparison of clinical outcomes for single- and double-balloon enteroscope-assisted endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy","volume":"31","author":"Han","year":"2025","journal-title":"World J. Gastroenterol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e02040","DOI":"10.14309\/crj.0000000000002040","article-title":"Double-Balloon Enteroscopy Enhanced with a Magnetic Balloon Anchoring System: A Triple Balloon Novel Approach for Diagnosis and Treatment of Small Bowel Lesions","volume":"13","author":"Minerba","year":"2026","journal-title":"ACG Case Rep. J."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1016\/j.giec.2022.02.001","article-title":"Biliary Endoscopy in Altered Anatomy","volume":"32","author":"Zhang","year":"2022","journal-title":"Gastrointest. Endosc. Clin. N. Am."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"2416607","DOI":"10.1080\/07853890.2024.2416607","article-title":"Endoscopic ultrasound-guided biliary rendezvous after failed cannulation, and comparison between benign vs malignant biliopancreatic disorders: Outcomes at a single tertiary-care centre","volume":"56","author":"Gornals","year":"2024","journal-title":"Ann. Med."},{"key":"ref_52","first-page":"1119","article-title":"Endoscopic ultrasound-directed transenteric ERCP (EDEE) in patients with postsurgical anatomy\u2014Novel but challenging","volume":"51","author":"Khashab","year":"2019","journal-title":"Endoscopy"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1055\/a-1376-2394","article-title":"Endoscopic ultrasound-directed transgastric ERCP (EDGE): A systematic review describing the outcomes, adverse events, and knowledge gaps","volume":"54","author":"Prakash","year":"2022","journal-title":"Endoscopy"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1055\/s-0034-1390771","article-title":"Endoscopic ultrasound-directed transgastric ERCP (EDGE) for Roux-en-Y anatomy: A novel technique","volume":"47","author":"Kedia","year":"2015","journal-title":"Endoscopy"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1080\/00365521.2022.2111228","article-title":"Endoscopic ultrasound-guided biliary drainage in patients with surgically altered anatomy: A systematic review and Meta-analysis","volume":"58","author":"Tanisaka","year":"2023","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"101888","DOI":"10.1016\/j.bpg.2024.101888","article-title":"Complications and management of interventional endoscopic ultrasound: A critical review","volume":"69","author":"Fabbri","year":"2024","journal-title":"Best Pract. Res. Clin. Gastroenterol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1","DOI":"10.14740\/gr1793","article-title":"Analysis of Adverse Events of Endoscopic Ultrasound-Guided Lumen-Apposing Metal Stent Placement: Insights Across Various Indications and Techniques","volume":"18","author":"Abusuliman","year":"2025","journal-title":"Gastroenterol. Res."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1055\/s-2001-17324","article-title":"Endoscopic ultrasound-guided bilioduodenal anastomosis: A new technique for biliary drainage","volume":"33","author":"Giovannini","year":"2001","journal-title":"Endoscopy"},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Alfieri, D., Delogu, C., Mazza, S., Mauro, A., Bartolotta, E., Cappellini, A., Scalvini, D., Torello Viera, F., Bardone, M., and Anderloni, A. (2025). The Role and Appropriate Selection of Guidewires in Biliopancreatic Endoscopy. Medicina, 61.","DOI":"10.3390\/medicina61050913"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1016\/j.gie.2024.11.005","article-title":"Usefulness of a dedicated laser-cut metal stent with an anchoring hook and thin delivery system for EUS-guided hepaticogastrostomy in malignant biliary obstruction: A prospective multicenter trial (with video)","volume":"101","author":"Itonaga","year":"2025","journal-title":"Gastrointest. Endosc."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.1111\/jgh.14112","article-title":"Efficacy of the 6-mm fully covered self-expandable metal stent during endoscopic ultrasound-guided hepaticogastrostomy as a primary biliary drainage for the cases estimated difficult endoscopic retrograde cholangiopancreatography: A prospective clinical study","volume":"33","author":"Okuno","year":"2018","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1055\/a-2282-3350","article-title":"Efficacy and safety of endoscopic ultrasound-guided hepaticogastrostomy: A meta-regression analysis","volume":"56","author":"Binda","year":"2024","journal-title":"Endoscopy"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1055\/s-0029-1243858","article-title":"Endoscopic ultrasound (EUS)-guided transhepatic anterograde self-expandable metal stent (SEMS) placement across malignant biliary obstruction","volume":"42","author":"Binmoeller","year":"2010","journal-title":"Endoscopy"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1551","DOI":"10.1007\/s10620-022-07655-w","article-title":"Endoscopic Ultrasound-Guided Antegrade Stent Placement in Patients with Failed ERCP as a Modality of Preoperative and Palliative Biliary Drainage","volume":"68","author":"Sundaram","year":"2023","journal-title":"Dig. Dis. Sci."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.vgie.2020.09.011","article-title":"Combined bridging and antegrade stent placement during transmural treatment for malignant hilar biliary obstruction in a patient with surgically altered anatomy","volume":"6","author":"Atalla","year":"2020","journal-title":"VideoGIE"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"E127","DOI":"10.1055\/s-0043-123188","article-title":"Endoscopic ultrasound-guided hepaticogastrostomy and antegrade clearance of biliary lithiasis in patients with surgically-altered anatomy","volume":"6","author":"Hosmer","year":"2018","journal-title":"Endosc. Int. Open"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1111\/den.14393","article-title":"Current status of endoscopic ultrasound-guided antegrade intervention for biliary diseases in patients with surgically altered anatomy","volume":"35","author":"Iwashita","year":"2023","journal-title":"Dig. Endosc."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/S0016-5107(03)02300-9","article-title":"EUS-guided rendezvous (RV) drainage of obstructed biliary and pancreatic ducts: Report of 6 cases","volume":"59","author":"Mallery","year":"2004","journal-title":"Gastrointest. Endosc."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"E400","DOI":"10.1055\/a-2587-8500","article-title":"Same-session endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis with lumen-apposing metal stent and rendezvous for biliary stones in invisible papilla","volume":"57","author":"Scalvini","year":"2025","journal-title":"Endoscopy"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1097\/MCG.0000000000001543","article-title":"Effectiveness and Safety of EUS Rendezvous After Failed Biliary Cannulation With ERCP: A Systematic Review and Proportion Meta-analysis","volume":"57","author":"Klair","year":"2023","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1111\/den.14636","article-title":"Endoscopic ultrasound-rendezvous versus percutaneous-endoscopic rendezvous endoscopic retrograde cholangiopancreatography for bile duct access: Systematic review and meta-analysis","volume":"36","author":"Yoon","year":"2024","journal-title":"Dig. Endosc."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"E1782","DOI":"10.1055\/a-1264-7511","article-title":"EUS-guided intrahepatic biliary drainage: A large retrospective series and subgroup comparison between percutaneous drainage in hilar stenoses or postsurgical anatomy","volume":"8","author":"Vanella","year":"2020","journal-title":"Endosc. Int. Open"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"4144","DOI":"10.1007\/s00464-023-09926-7","article-title":"Efficacy & safety of EUS-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE) in Roux-en-Y gastric bypass anatomy: A systematic review & meta-analysis","volume":"37","author":"Deliwala","year":"2023","journal-title":"Surg. Endosc."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"2776","DOI":"10.1007\/s10620-020-06551-5","article-title":"Shortened-Interval Dual-Session EDGE Reduces the Risk of LAMS Dislodgement While Facilitating Timely ERCP","volume":"66","author":"Krafft","year":"2021","journal-title":"Dig. Dis. Sci."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1016\/j.gie.2022.05.008","article-title":"EDGI study group. EUS-directed transgastric interventions in Roux-en-Y gastric bypass anatomy: A multicenter experience","volume":"96","author":"Ghandour","year":"2022","journal-title":"Gastrointest. Endosc."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1055\/a-1254-3942","article-title":"Endoscopic ultrasound-directed transgastric ERCP (EDGE): A retrospective multicenter study","volume":"53","author":"Runge","year":"2021","journal-title":"Endoscopy"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1016\/j.gie.2021.04.022","article-title":"Maximizing success in single-session EUS-directed transgastric ERCP: A retrospective cohort study to identify predictive factors of stent migration","volume":"94","author":"Shinn","year":"2021","journal-title":"Gastrointest. Endosc."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1111\/den.14879","article-title":"Single-session endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography with a dedicated over-the-scope fixation device: Feasibility study (with video)","volume":"37","author":"Bronswijk","year":"2025","journal-title":"Dig. Endosc."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1097\/eus.0000000000000032","article-title":"Efficacy and safety of EUS-directed transgastric ERCP (EDGE) versus laparoscopic-assisted ERCP: A systematic review and meta-analysis","volume":"13","author":"Gangwani","year":"2024","journal-title":"Endosc. Ultrasound"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1097\/MCG.0000000000001037","article-title":"EUS-directed Transgastric ERCP (EDGE) Versus Laparoscopy-assisted ERCP (LA-ERCP) for Roux-en-Y Gastric Bypass (RYGB) Anatomy: A Multicenter Early Comparative Experience of Clinical Outcomes","volume":"53","author":"Kedia","year":"2019","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"5259","DOI":"10.1007\/s00464-019-07310-y","article-title":"Outcomes of laparoscopic-assisted ERCP in gastric bypass patients at a community hospital center","volume":"34","author":"Mohammad","year":"2020","journal-title":"Surg. Endosc."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"6682","DOI":"10.1007\/s00464-023-10276-7","article-title":"Safety and efficacy of LA-ERCP procedure following Roux-en-Y gastric bypass: A systematic review and meta-analysis","volume":"37","author":"Saad","year":"2023","journal-title":"Surg. Endosc."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1007\/s11695-024-07459-z","article-title":"Understanding the Role of Different ERCP Techniques in Post-Roux-en-Y Gastric Bypass Patients: A Systematic Review and Meta-analysis","volume":"35","author":"Rancz","year":"2025","journal-title":"Obes. Surg."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1007\/s00464-021-08328-x","article-title":"Laparoscopic-assisted ERCP following RYGB: A 12-year assessment of outcomes and learning curve at a high-volume pancreatobiliary center","volume":"36","author":"AlMasri","year":"2022","journal-title":"Surg. Endosc."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1007\/s11695-020-04946-x","article-title":"Efficacy and Safety of 100 Laparoscopy-Assisted Transgastric Endoscopic Retrograde Cholangiopancreatography Procedures in Patients with Roux-en-Y Gastric Bypass","volume":"31","author":"Koggel","year":"2021","journal-title":"Obes. Surg."},{"key":"ref_86","doi-asserted-by":"crossref","unstructured":"Tarantino, I., and Rizzo, G.E.M. (2021). Biliopancreatic Endoscopy in Altered Anatomy. Medicina, 57.","DOI":"10.3390\/medicina57101014"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"E1322","DOI":"10.1055\/s-0042-110790","article-title":"EUS-guided biliary drainage or enteroscopy-assisted ERCP in patients with surgical anatomy and biliary obstruction: An international comparative study","volume":"4","author":"Khashab","year":"2016","journal-title":"Endosc. Int. Open"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1111\/den.70010","article-title":"Balloon Enteroscopy-Assisted ERCP Versus Endoscopic Ultrasound-Guided Biliary Drainage for Unresectable Malignant Biliary Obstruction in Patients with Surgically Altered Anatomy: A Multicenter Prospective Registration Study","volume":"37","author":"Itonaga","year":"2025","journal-title":"Dig. Endosc."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1097\/MCG.0000000000001949","article-title":"Comparing EUS-directed Transgastric ERCP (EDGE) Versus Laparoscopic-Assisted ERCP Versus Enteroscopic ERCP: A Network Meta-analysis","volume":"58","author":"Gangwani","year":"2024","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1055\/a-0938-3918","article-title":"Cost-effectiveness of endoscopic ultrasound-directed transgastric ERCP compared with device-assisted and laparoscopic-assisted ERCP in patients with Roux-en-Y anatomy","volume":"51","author":"James","year":"2019","journal-title":"Endoscopy"},{"key":"ref_91","first-page":"e30196","article-title":"Laparoscopic-Assisted ERCP Versus Endoscopic Ultrasound-Directed Transgastric ERCP in Patients with Roux-en-Y Gastric Bypass: A Systematic Review and Meta-Analysis","volume":"14","author":"Ribeiro","year":"2022","journal-title":"Cureus"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"E423","DOI":"10.1055\/a-1070-9132","article-title":"Laparoscopy-assisted versus enteroscopy-assisted endoscopic retrograde cholangiopancreatography (ERCP) in Roux-en-Y gastric bypass: A meta-analysis","volume":"8","author":"Ayoub","year":"2020","journal-title":"Endosc. Int. Open"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1177\/1457496917731192","article-title":"Palliation of Malignant Biliary Obstruction: Adverse Events are Common after Percutaneous Transhepatic Biliary Drainage","volume":"107","author":"Heedman","year":"2018","journal-title":"Scand. J. Surg."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/9\/1766\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T11:09:34Z","timestamp":1789384174000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/9\/1766"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,14]]},"references-count":93,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["medicina62091766"],"URL":"https:\/\/doi.org\/10.3390\/medicina62091766","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,14]]}}}