Post written by Kazumasa Nagai, MD, PhD, from Tokyo Medical University, Tokyo, Japan.

Bilioenteric anastomotic stricture (BES) is a significant adverse event after hepaticojejunostomy. Recently, EUS-guided antegrade intervention (EUS-AI) has been developed in cases of balloon enteroscopy–assisted ERCP failure. Several reports have demonstrated the efficacy and safety of EUS-AI.

However, the results of these studies were limited to short-term outcomes, and no studies have reported long-term outcomes after EUS-AI. Furthermore, some cases show recurrent cholangitis, even after successful biliary drainage. Practically, refractory cholangitis after anastomotic stricture can lead to secondary biliary cirrhosis or hepatic failure in the long term.

Therefore, we conducted a single-center retrospective study to identify the long-term outcomes of EUS-AI for BES in patients with surgically altered anatomy.

There are 3 strong points of our study: (1) To our knowledge, this is the first study to show the long-term outcomes of EUS-AI for BES; (2) we clarify the factors associated with stricture resolution after EUS-AI in the long-term clinical course; (3) to our knowledge, this is the first study to identify the frequency of hepatic fibrosis progression during follow-up and risk factors for development of fibrosis.

During the median follow-up period of 56.7 months, the stricture resolution rate was 50%, and the rate of recurrence after stent removal was 33%. After EUS-AI, 25% of the patients with BES progressed to hepatic fibrosis. In addition, we clarified the associated factors of stricture resolution and the risk factors of hepatic fibrosis progression.

In the future, we plan to prospectively collect the BES cases and evaluate hepatic fibrosis using magnetic resonance imaging elastography. We seek to develop an appropriate treatment strategy for BES.

Long-term outcomes of patients undergoing EUS-HGS for benign bilioenteric anastomotic strictures. EUS-HGS, EUS-guided hepaticogastrostomy.

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