Accessing the Pancreatobiliary System via Lumen‐Apposing Metal Stents: A State‐of‐the‐Art Review of Endoscopic Ultrasound‐Directed Interventions
Year: 2026
Type: article
Abstract: The growing number of bariatric and oncologic gastrointestinal and hepatopancreatobiliary surgeries has fueled the increased need for biliary interventions in patients with surgically altered anatomy (SAA), where standard endoscopic retrograde cholangiopancreatography (ERCP) is often unfeasible. Traditional alternative methods, such as enteroscopy- or laparoscopy-assisted ERCP, are associated with technical and logistical limitations. Endoscopic ultrasound (EUS)-directed ERCP uses lumen-apposing metal stents (LAMS) to create temporary anastomoses between adjacent lumens, thus restoring access for standard ERCP. These procedures include EUS-directed transgastric (EDGE), transenteric (EDEE), transduodenal (EDDE), and transcholedochal/transcystic (EDCE) ERCP. This review provides an evidence-based analysis of the available techniques and comparative outcomes, with a particular focus on technical and strategic aspects including: (1) how to create an EUS-guided anastomosis across different surgical scenarios; (2) how to perform a through-the-LAMS ERCP, including endoscope and accessory selection, ERCP timing and LAMS fixation; and (3) how to manage the fistula after completion of therapy, including timing of LAMS removal and fistula closure. An algorithm is proposed to guide the endoscopist through the complex decision-making inherent to pancreatobiliary interventions in SAA.
Source: Digestive Endoscopy
DOI: 10.1111/den.70098
Authors: Giuseppe Vanella, Michiel Bronswijk, Enrique Pérez‐Cuadrado‐Robles, Roy L. J. van Wanrooij, Prabhleen Chahal, Edoardo Forti, Camilla Gallo, Marco Spadaccini, Alessandro Fugazza, Mouen Khashab, Amrita Sethi, Amy Tyberg, Manuel Perez‐Miranda, Massimiliano Mutignani, Rastislav Kunda, Michel Kahaleh, Schalk Van der Merwe, Paolo Giorgio Arcidiacono
Institutions: Vita-Salute San Raffaele University, Universitair Ziekenhuis Leuven, Imelda Hospital, KU Leuven, Hôpital Européen Georges-Pompidou, Amsterdam University Medical Centers, Amsterdam UMC Location Vrije Universiteit Amsterdam, The University of Texas at San Antonio Health Science Center, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Humanitas University, IRCCS Humanitas Research Hospital, Johns Hopkins Hospital, Northwestern Medicine, Hackensack Meridian School of Medicine, Hospital Universitario Río Hortega, National University of Singapore, National University Hospital
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W7127317744