P2289 - Successful Biliary Re-Cannulation and Neo-Anastomosis Creation in Complete Bile Duct Occlusion or Disruption Using a Combination of Interventional Radiology and Endoscopy Techniques: A Case Series

Award: Presidential Poster Award

Shajan Peter, MD¹, Husameddin El Khudari, MD¹, Ali Mir Ahmed, MD¹, Dalton A. Norwood, MD², Sergio A. Sánchez-Luna, MD³, Eric Bready, MD¹, Ramzi Mulki, MD³, Kondal Kyanam, MD³, Andrew J Gunn, MD^1
1University of Alabama at Birmingham, Birmingham, AL; ²UAB Minority Health and Health Equity Research Center, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL; ³Basil I. Hirschowitz Endoscopic Center of Excellence, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL

Introduction: Total biliary occlusion or high-grade leaks are rare but challenging complications of hepatic-biliary-related surgical interventions. This accounts to failure of endoscopic or IR drainage interventions. Recanalization of the biliary tree in these circumstances is a potential solution and require a multidisciplinary approach. We aimed to report a case series of patients who underwent biliary recanalization or neo- anastomosis by interventional radiology (IR) and endoscopic assistance.

Methods: Patients who underwent biliary recanalization procedures over the last 3 years were included in this IRB-approved study of a prospectively collected database. Patients were included if they had non-malignant, post-surgical complete or non-traversable biliary anatomy and percutaneous bilioenteric neo-anastomosis or if a neoduct creation was performed. Basic demographic, procedural data, immediate, and long-term follow-up outcomes were recorded and analyzed.



Results: A total of six patients (67% female) were included (Table 1). The mean age was 63.8 (10.6). Five patients had total bile duct occlusion while one patient had complete bile duct disruption. Re-cannulation of the existing biliary tree was accomplished in three patients using a radiofrequency (RF) wire percutaneously with endoscopic guidance (n=1), back end of a Glidewire (n=1), and percutaneous targeting of an occluded bare-metal stent (n=1). Neo-anastomosis creation was accomplished in the other three patients using a 22G needle under fluoroscopic guidance (n=1), a 22G needle under endoscopic guidance (n=1), and a rendezvous procedure between IR and endoscopy (n=1). Cholangioscopy was used in three patients. Technical success in biliary reconstruction was thus 100%. One major adverse event occurred (post-procedure bacteremia treated with antibiotics). There were no procedure-related deaths. Four of six patients no longer required an internal/external biliary drain while two patients are progressing toward drain removal.

Discussion: In refractory total bile duct occlusion or disruption, reconstruction of the biliary tree can be successfully performed in a multi-disciplinary approach combining endoscopic and IR techniques, which can be a safer alternative to major surgical revision. A combination of tools from IR and endoscopy are valuable in successful re-cannulation or neo-anastomosis formation. Further studies will shed light on the long-term outcomes.



Disclosures:


Shajan Peter, MD¹, Husameddin El Khudari, MD¹, Ali Mir Ahmed, MD¹, Dalton A. Norwood, MD², Sergio A. Sánchez-Luna, MD³, Eric Bready, MD¹, Ramzi Mulki, MD³, Kondal Kyanam, MD³, Andrew J Gunn, MD¹. P2289 - Successful Biliary Re-Cannulation and Neo-Anastomosis Creation in Complete Bile Duct Occlusion or Disruption Using a Combination of Interventional Radiology and Endoscopy Techniques: A Case Series, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.