Int J Gastrointest Interv.  2025 Jan;14(1):2-8. 10.18528/ijgii240070.

Emergent treatment using balloon-assisted ERCP versus EUS-guided drainage for acute cholangitis in patients with surgically altered anatomy

• Shishimoto T
• Itonaga M
• Ashida R
• Yamashita Y
• Kawaji Y
• Tamura T
• Morishita H
• Nakahata A
• Sugihara Y
• Ishihara T
• Kitano M

• KMID: 2564823
• DOI: http://doi.org/10.18528/ijgii240070

Abstract

Background
No studies have compared balloon-assisted endoscope-guided endoscopic retrograde cholangiopancreatography (BAE-ERCP) and endoscopic ultrasonography-guided biliary drainage (EUS-BD) for emergent treatment of acute cholangitis (AC) in patients with upper gastrointestinal surgically altered anatomy (SAA).
Methods
This study retrospectively evaluated consecutive patients who underwent emergent BAE-ERCP or EUS-BD for AC with SAA between January 2020 and March 2024. Technical success, clinical success, procedure time, and adverse events (AEs) were compared between the two groups.
Results
This study included 23 patients in the BAE-ERCP group and 14 patients in the EUS-BD group. Technical success and clinical success rates did not significantly differ between the two groups (88% vs. 100%, P = 0.51 and 95% vs. 93%, P = 0.66). Similarly, the rate of AEs was comparable between the two groups (4% vs. 14%, P = 0.54). The median procedure time was significantly shorter in the EUS-BD group than in the BAE-ERCP group (32.5 [interquartile range; IQR, 28.8–52.5] minutes vs. 70.0 [IQR, 60.0–90.0] minutes, P < 0.01). In cases with grade 2 or 3 cholangitis, the rates of technical success, clinical success, and AEs did not significantly differ between the two groups. However, the median procedure time was significantly shorter in the EUS-BD group than in the BAE-ERCP group (32.5 [IQR, 28.8–52.5] minutes vs. 70 [IQR, 56.3–90.0] minutes, P < 0.01).
Conclusion
While both BAE-ERCP and EUS-BD can be performed safely and effectively in patients with AC and SAA, the procedure time is significantly shorter with EUS-BD than with BAE-ERCP.

Keyword

Adverse effects; Balloon enteroscopy; Cholangiopancreatography, endoscopic retrograde; Gastric bypass; Humans