BackgroundBariatric gastric bypass surgery is being increasingly performed, but endoscopic retrograde cholangiopancreatography (ERCP) in these patients poses a unique challenge because of a lack of per-oral access to the stomach. Small series suggest a higher technical success rate using laparoscopy-assisted ERCP (LA-ERCP) than with an enteroscopic approach via the Roux-en-Y anastomosis. We present initial experience of LA-ERCP in our unit.DesignRetrospective case series of consecutive patients undergoing LA-ERCP in our unit between September 2011 and July 2014. Data was retrieved from electronic, clinical and endoscopy records.ResultsSeven LA-ERCPs were performed. All seven patients were female, with median age 44 years (range 36–71). Indications included symptomatic bile duct stones (5/7), benign papillary fibrosis (1/7) and retained biliary stent (1/7). 5/7 (71%) patients had had a prior cholecystectomy. To facilitate LA-ERCP, laparoscopic gastrostomy ports were created in all patients. Duodenal access, biliary cannulation and completion of therapeutic aim were achieved in all patients. 6/7 (86%) patients required endoscopic sphincterotomy. The median duration of procedures was 94 min (range 70–135). Median postoperative length of stay was 2 days (range 1–9). One patient developed mild postprocedural acute pancreatitis, and another patient developed a mild port-site infection. Otherwise, no procedure-related complications were seen. All patients remained well on follow-up (median 14 months (range 1–35) from date of ERCP), with no evidence of further biliary symptoms.ConclusionsOur early experience of LA-ERCP is that it is safe and effective. The technique may require particular consideration, as bariatric surgery is increasingly performed, in a patient group at significant risk of bile duct stones.
Abstract. MR image acquisition of moving organs remains challenging despite the advances in ultra-fast 2D MRI sequences. Post-acquisition techniques have been proposed to increase spatial resolution a posteriori by combining acquired orthogonal stacks into a single, high-resolution (HR) volume. Current super-resolution techniques classically rely on a two-step procedure. The volumetric reconstruction step leverages a physical slice acquisition model. However, the motion correction step typically neglects the point spread function (PSF) information. In this paper, we propose a PSF-aware slice-to-volume registration approach and, for the first time, demonstrate the potential benefit of Super-Resolution for upper abdominal imaging. Our novel reconstruction pipeline takes advantage of different MR acquisitions clinically used in routine MR cholangiopancreatography studies to guide the registration. On evaluation of clinically relevant image information, our approach outperforms state-of-theart reconstruction toolkits in terms of visual clarity and preservation of raw data information. Overall, we achieve promising results towards replacing currently required CT scans.
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