Endoscopic Biliary Drainage in Surgically Altered Anatomy.

Endoscopic retrograde cholangiopancreatography (ERCP) is considered the preferred method for managing biliary obstructions. However, the prevalence of surgically modified anatomies often poses challenges, making the standard side-viewing duodenoscope unable to reach the papilla in most cases. The increasing instances of surgically altered anatomies (SAAs) result from higher rates of bariatric procedures and surgical interventions for pancreatic malignancies. Conventional ERCP with a side-viewing endoscope remains effective when there is continuity between the stomach and duodenum. Nonetheless, percutaneous transhepatic biliary drainage (PTBD) or surgery has historically been used as an alternative for biliary drainage in malignant or benign conditions. The evolving landscape has seen various endoscopic approaches tailored to anatomical variations. Innovative methodologies such as cap-assisted forward-viewing endoscopy and enteroscopy have enabled the performance of ERCP. Despite their utilization, procedural complexities, prolonged durations, and accessibility challenges have emerged. As a result, there is a growing interest in novel enteroscopy and endoscopic ultrasound (EUS) techniques to ensure the overall success of endoscopic biliary drainage. Notably, EUS has revolutionized this domain, particularly through several techniques detailed in the review. The rendezvous approach has been pivotal in this field. The antegrade approach, involving biliary tree puncturing, allows for the validation and treatment of strictures in an antegrade fashion. The EUS-transmural approach involves connecting a tract of the biliary system with the GI tract lumen. Moreover, the EUS-directed transgastric ERCP (EDGE) procedure, combining EUS and ERCP, presents a promising solution after gastric bypass. These advancements hold promise for expanding the horizons of comprehensive and successful biliary drainage interventions, laying the groundwork for further advancements in endoscopic procedures.

Ictericia obstructiva benigna y maligna: utilidad clínica del CA 19-9 / Benign and malignant obstructive jaundice: clinical ultility of CA 19-9

Introducción: Se estableció como objetivo determinar la utilidad clínica del marcador tumoral CA 19-9 en ictericia obstructiva de origen benigno y maligno en pacientes adultos que acuden al servicio de gastroenterología del Hospital Universitario de Caracas. Pacientes y métodos: se estableció como muestra a todos los pacientes que fueron hospitalizados en el Servicio de Gastroenterología del Hospital Universitario de Caracas con ictericia obstructiva, a los cuales se les realizó la determinación del CA 19-9 antes y siete días después del drenaje de la vía biliar a través de una colangiopancreatografía retrógrada endoscópica y se determinó la variación de los valores de CA 19-9 y si este valor permitió diferenciar entre ambas etiologías. Resultados: Los valores de CA 19-9 no se modificaron de forma significativa después del drenaje biliar en la patología benigna ni en la maligna. Se obtuvo un nuevo punto de corte para el CA 19-9 (47U/L), manteniendo la sensibilidad, pero aumentando la especificidad. Conclusiones:No se puede utilizar la variación del CA 19-9 después del drenaje biliar como elemento diagnóstico para diferenciar entre enfermedad benigna o maligna biliopancreática.

Aim: to determinate the clinical utility of the tumor marker CA 19-9 in obstructive jaundice of benign and malignant origin in adult patients who comes to the service of gastroenterology of the Caracas University Hospital.Patients and methods: was stablish as sample every patient who undergo hospitalization in the service of gastroenterology Caracas University Hospital with obstructive jaundice in which was determinate the CA 19-9 before and seven days after the drainage of the biliary pathway with endoscopic retrograde colangiopancreatography and was determinate the variation of the results of the CA 19-9 and if this result can differentiate between both etiologies. Results: the values of CA19-9 did not modified in significant way after the biliary drainage in the benign and malignant pathology. It was obtained a new cohort point of the CA 19-9 (47U/L), keeping the sensitivity, but increasing the specificity. Conclusions: it can’t be used the variation of the CA 19-9 after the biliary drainage as diagnostic element to differentiate between benign and malignant pathology..