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The following is a summary of “Endoscopic biliary drainage in patients with surgically-altered anatomy: the street multicenter study,” published in the April 2025 issue of the Gastrointestinal Endoscopy by Mauro et al.

Endoscopic biliary drainage (BD) in patients with surgically altered anatomy (SAA) remains a complex and technically demanding clinical scenario. Although several BD approaches are currently available, there is no universal standardization, and the choice of technique often depends on institutional expertise and local resources. This study aimed to evaluate real-world practices and outcomes associated with different BD approaches in patients with SAA across multiple centers.

This retrospective, multicenter cohort study included adult patients with a history of SAA who underwent endoscopic BD for any clinical indication over the past five years. Outcomes were analyzed based on the type of surgical reconstruction, clinical indication for BD, and the specific endoscopic techniques employed. Primary outcomes included technical success, clinical success, and adverse event rates, while secondary outcomes assessed the evolution of BD strategies over time.

A total of 432 patients were included in the analysis. The overall technical success rate of BD procedures was 80.3%, with a corresponding clinical success rate of 79.9%. Outcomes did not significantly differ across the various types of surgical reconstructions, with the exception of a higher adverse event rate observed in patients with Billroth-II anatomy (14.4%). Among patients with Roux-en-Y reconstruction, there was notable heterogeneity in the BD approaches utilized, including a greater reliance on advanced techniques such as device-assisted enteroscopy, ERCP and interventional EUS.

Importantly, interventional EUS procedures became more prevalent during the most recent two years of the study period. This shift was associated with a markedly higher likelihood of clinical success compared to other BD modalities ([OR] = 7.87; 95% [CI], 2.56–24.13; p < 0.001), alongside a reduced rate of reintervention during follow-up.

In conclusion, endoscopic BD in patients with SAA continues to present challenges, with success rates remaining suboptimal across all types of surgical reconstructions. However, the increasing adoption of interventional EUS techniques has led to significant improvements in clinical outcomes, suggesting that EUS-guided approaches may represent an important advancement in the management of this complex patient population. Further prospective studies are warranted to refine treatment algorithms and optimize outcomes in this setting.

Source: giejournal.org/article/S0016-5107(25)01625-6/abstract