{
  "abstract": "Introduction Managing biliary disease in patients with surgically-altered anatomy remains a challenge. Antegrade cholangioscopy (AC) can be performed either via interventional radiology–guided percutaneous transhepatic cholangiography (IR-PTC) or endoscopic ultrasound–guided hepatico-gastrostomy (EUS-HGS). This is an advanced technique that allows direct visualisation of the biliary tree for interventions such as electrohydraulic lithotripsy (EHL) for complex stone disease and targeted biopsies (Spybites™) for indeterminate strictures. This is a retrospective case-series in a high-volume tertiary centre which aims to demonstrate that AC is both safe and effective.Methods This is a retrospective review of all patients who underwent AC at a single centre from January 2020 to October 2025. Procedures were performed either via IR-PTC or EUS-HGS using a Spyglass™ cholangioscope. Patient demographics, surgical anatomy, procedural indications, techniques, and clinical outcomes were analysed.Results 25 patients underwent AC; 22 via percutaneous access and 3 via EUS-HGS. Median age was 64 years, 52% were male.23 patients had surgically-altered anatomy which precluded transpapillary access; 13 had a Roux-en-Y hepaticojejunostomy, 5 had a R-en-Y gastric bypass, 2 had a R-en-Y Whipple’s procedure, 2 had a total gastrectomy with R-en-Y reconstruction and 1 had a Billroth II gastrectomy. 1 patient had extensive head and neck surgery and 1 had an uncovered metal stent through the right hepatic system which precluded left-sided biliary access.19 patients needed cholangioscopy with EHL for stone disease, while 6 patients needed Spybites™ for stricture assessment, 3 were found to be malignant.The date of PTC insertion was not available for 6 patients (done at referring hospital). The median number of days between gaining biliary access and first cholangioscopy was 59 days. Patients with PTC had an external drain for a median of 69 days. HGS stents did not need removing. 23 patients had antibiotics at the time of AC and for at least 3 days afterwards. Clinical success, defined as stone clearance or diagnosis clarification, was achieved in all patients.1 patient developed post-procedure bleeding following PTC catheter removal requiring embolisation and a 6-day ICU admission. There was no mortality at 30 days.Conclusion In this single-centre experience, AC was safe and effective in patients with surgically-altered anatomy. All procedures were done in a high-volume endoscopy centre with an experienced IR team. The majority of patients received antibiotics to reduce the risk of biliary sepsis. Complications were uncommon with no patients requiring surgical intervention, however patients needing percutaneous access had an external drain for a median of 10 weeks. With increasing EUS expertise, a shift towards endoscopic access may reduce the need for prolonged external drainage associated with percutaneous approaches.",
  "authors": [
    {
      "affiliations": [
        "University College London Hospital, London, United Kingdom"
      ],
      "name": "Lynn Affarah"
    },
    {
      "affiliations": [
        "University College London Hospital, London, United Kingdom"
      ],
      "name": "Alan Marrinan"
    },
    {
      "affiliations": [
        "University College London Hospital, London, United Kingdom"
      ],
      "name": "Danujan Sriranganathan"
    },
    {
      "affiliations": [
        "University College London Hospital, London, United Kingdom"
      ],
      "name": "Michael Chapman"
    },
    {
      "affiliations": [
        "University College London Hospital, London, United Kingdom"
      ],
      "name": "Gavin Johnson"
    },
    {
      "affiliations": [
        "University College London Hospital, London, United Kingdom"
      ],
      "name": "Tareq El-Menabawey"
    },
    {
      "affiliations": [
        "University College London Hospital, London, United Kingdom"
      ],
      "name": "Simon Philpotts"
    },
    {
      "affiliations": [
        "University College London Hospital, London, United Kingdom"
      ],
      "name": "Prof Stephen Pereira"
    },
    {
      "affiliations": [
        "University College London Hospital, London, United Kingdom"
      ],
      "name": "George Webster"
    }
  ],
  "title": "P351 Antegrade cholangioscopy: a single-centre experience",
  "uid": "4c4d966e-f75c-5fbf-a42a-3f08438f1958"
}