Background Endoscopic ultrasound (EUS)-guided transhepatic antegrade stone removal (TASR) is reserved for choledocholithiasis after failed ERCP in recent years. The aim of this study was to evaluate the techniques, feasibility and safety of simplified single-session EUS-TASR for choledocholithiasis in patients with surgically altered anatomy (SAA).

Methods A retrospective database of patients with SAA and choledocholithiasis from The Second Hospital of Hebei Medical University (Shijiazhuang, China) between August 2020 and February 2023 was performed. They all underwent single-session EUS-TASR after ERCP failure. Basic characteristics of the patients and details of the procedures were collected. The success rates and adverse events were evaluated and discussed.

Results During the study period, 13 patients underwent single-session EUS-TASR as a rescue procedure (8 males, median age, 64 [IQR, 48.5–69.5] years). SAA consisted of four Whipple procedures, one Billroth II gastrectomy, four Gastrectomy with Roux-en-Y anastomosis and four Hepaticojejunostomy with Roux-en-Y anastomosis. The technical success rate was 100%, and successful bile duct stone removal was achieved in 12 of the patients (92.3%). Adverse events occurred in two patients (15.4%), while one turned to laparoscopic surgery and the other was managed conservatively.

Conclusions Single-session EUS-TASR, as a rescue procedure after ERCP failure, appeared to be effective and safe in the management of choledocholithiasis in patients with SAA. However, further evaluation of this technique is still needed, preferably through prospective multicenter trials.