©The Author(s) 2026. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 14, 2026; 32(2): 113071
Published online Jan 14, 2026. doi: 10.3748/wjg.v32.i2.113071
Published online Jan 14, 2026. doi: 10.3748/wjg.v32.i2.113071
Biliary drainage in patients with altered anatomy: Literature review of different endoscopic approaches
Silvia Cocca, Alessandro Grova, Marinella Lupo, Mario Ferrante, Giuseppe Grande, Flavia Pigò, Tancredi Vincenzo Li Cavoli, Rita Conigliaro, Helga Bertani, Gastroenterology and Endoscopy Unit, Azienda Ospedaliero Universitaria Policlinico di Modena, Modena 41124, Emilia-Romagna, Italy
Gianmaria Casoni Pattacini, Sofia Esposito, Micaela Piccoli, Department of General, Emergency Surgery and New Technologies, Baggiovara General Hospital, Modena 41126, Emilia-Romagna, Italy
Chiara Guidotti, Department of Health Professions, Fondazione Policlinico Universitario Campus Bio-Medico, Rome 00128, Lazio, Italy
Alessandro Mussetto, Department of Gastroenterology, Santa Maria Della Croci Hospital, Ravenna 48121, Emilia-Romagna, Italy
Author contributions: Cocca S, Grova A and Ferrante M contributed to conceptualization and writing - original draft; Grova A, Ferrante M, Casoni Pattacini G, and Esposito S contributed to writing - review & editing; Bertani H, Conigliaro R, and Piccoli M contributed to supervision; Pigò F, Guidotti C, Li Cavoli TV and Grande G contributed to review and figures editing; Cocca S, Mussetto A, Lupo M and Bertani H contributed to supervision and conceptualization; and all authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Silvia Cocca, PhD, Gastroenterology and Endoscopy Unit, Azienda Ospedaliero Universitaria Policlinico di Modena, Via Pietro Giardini 1355, Modena 41124, Emilia-Romagna, Italy. silvia.cocca@gmail.com
Received: August 15, 2025
Revised: September 8, 2025
Accepted: November 25, 2025
Published online: January 14, 2026
Processing time: 150 Days and 13.4 Hours
Revised: September 8, 2025
Accepted: November 25, 2025
Published online: January 14, 2026
Processing time: 150 Days and 13.4 Hours
Core Tip
Core Tip: In patients with altered anatomy, endoscopic retrograde cholangiopancreatography is technically demanding and requires expertise in device-assisted enteroscopy. Success depends on anticipating limitations such as scope instability, restricted reach, and prolonged procedure time, and on recognizing when to switch to alternative strategies. Endoscopic ultrasound-guided drainage has become an important option in long-limb reconstructions, while percutaneous transhepatic biliary drainage remains the most frequently used rescue technique, with surgical alternatives still possible in selected cases. Highlighting these practical considerations helps distinguish expert-level decision-making from a general overview.