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Redefining endoluminal biliary drainage: Challenges and innovations in endosonography-guided techniques.

World J Gastroenterol

January 2025

Department of Gastroenterology and Hepatology, Campus Virchow/Campus Mitte, Charité Berlin, Berlin 10117, Germany.

Endoscopic retrograde cholangiopancreatography is considered the gold standard for treating benign and malignant biliary obstructions. However, its use in complex biliary obstructions is limited. Over the past decades, therapeutic endosonography (EUS) and emerging technologies such as lumen-apposing metal stents have enabled endoscopic treatment of conditions previously requiring non-endoscopic or surgical approaches.

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Endoscopic ultrasound (EUS)-guided interventions have revolutionized the management of malignant biliary obstruction (MBO) and gastric outlet obstruction (GOO), providing minimally invasive alternatives with improved outcomes. These procedures have significantly reduced the need for high-risk surgical interventions or percutaneous alternatives and have provided effective palliative care for patients with advanced gastrointestinal and bilio-pancreatic malignancies. EUS-guided biliary drainage (EUS-BD) techniques, including hepaticogastrostomy (EUS-HGS), choledochoduodenostomy (EUS-CDS), and antegrade stenting (EUS-AS), offer high technical and clinical success rates, with a good safety profile particularly when Endoscopic Retrograde Cholangiopancreatography (ERCP) is not feasible.

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Background: Stone impaction is an obstacle to successful laparoscopic common bile duct exploration (LCBDE). This study aims to identify the incidence, operative difficulties and techniques used to disimpact and remove impacted stones during LCBDE.

Methods: Prospectively collected data from a large series of LCBDE.

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Sump syndrome is a rare complication of biliary surgery that is now rarely seen in the era of Endoscopic Retrograde Cholangiopancreatography (ERCP). It occurs when the distal common bile duct becomes obstructed between an anastomosis from a choledochoduodenostomy (CDD) and the ampulla of Vater, forming a sump that accumulates debris. Sump syndrome should be considered as a diagnosis in patients who present with cholangitis or pancreatitis and any history of biliary diversion, regardless of the time of presentation.

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Purpose Of The Study: improving the surgical treatment of biliary pancreatitis by using a universal retractor and improved methods of omentobursostomy with drainage of the omental bursa.

Study Design: Non-randomized controlled clinical trial Material and methods: This study included thirty-nine patients who underwent surgical procedures between October 2022 and September 2023 in Semey, located in the Abay region. The study examined the general characteristics of surgical interventions performed for acute biliary pancreatitis using our proposed treatment methods and devices to improve the outcomes of acute biliary pancreatitis.

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