Endoscopic Retrograde Cholangiopancreatography (Ercp): Analysis of the Effectiveness and Safety of the Procedure in the Patient With Roux-en-Y Gastric Bypass

Abstract

Background: Obesity can be treated with bariatric surgery; but, excessive weight loss may lead to diseases of the bile duct such as cholelithiasis and choledocholithiasis. Endoscopic retrograde cholangiopancreatography is a diagnostic and therapeutic procedure for these conditions, and may be hampered by the anatomical changes after surgery. Aim: Report the efficacy and the safety of videolaparoscopy-assisted endoscopic retrograde cholangiopancreatography technique in patients after bariatric surgery with Roux-en-Y gastric bypass. Method: Retrospective study performed between 2007 and 2017. Data collected were: age, gender, surgical indication, length of hospital stay, etiological diagnosis, rate of therapeutic success, intra and postoperative complications. Results: Seven patients had choledocholithiasis confirmed by image exam, mainly in women. The interval between gastric bypass and endoscopic procedure ranged from 1 to 144 months. There were no intraoperative complications. The rate of duodenal papillary cannulation was 100%. Regarding complications, the majority of cases were related to gastrostomy, and rarely to endoscopic procedure. There were two postoperative complications, a case of chest-abdominal pain refractory to high doses of morphine on the same day of the procedure, and a laboratory diagnosis of acute pancreatitis after the procedure in an asymptomatic patient. The maximum hospital stay was four days. Conclusion: The experience with endoscopic retrograde cholangiopancreatography through laparoscopic gastrostomy is a safe and effective procedure, since most complications are related to the it and did not altered the sequence to perform the conventional cholangiopancreatography.

Bariatric Surgery in Brazilian Public Health System: The Good, the Bad and the Ugly, or a Long Way to Go. Yellow Sign!

“…It is the operation of choice for diabetics as it increases the secretion of GLP-1 (glucagon-like peptide-1). Among its disadvantages are higher morbidity and mortality, anemia, vitamin deficiency, hypoproteinemia, and anatomical changes that put more difficulties but do not hinder endoscopic bile duct procedures 10 .…”

Complications of Endoscopic Retrograde Cholangiopancreatography in Patients With Previous Bariatric Surgery

“…4 According to a prospective study by Shiffman et al, up to 38% of patients that underwent BS develop cholelithiasis after 6 months, and 41% of these patients become symptomatic. 5,6 Endoscopic retrograde cholangiopancreatography (ERCP) is often indicated because of the increased risk of biliary diseases from either underlying obesity or postsurgical rapid weight loss. 2,4 Given the technical challenges associated with performing ERCP in patients with altered anatomy, we hypothesized that patients who previously underwent BS would be at an increased risk for complications associated with ERCP such as cholangitis, pancreatitis, and cholecystitis.…”

“…In those undergoing BS, the rapid weight loss induces changes in bile composition 4. According to a prospective study by Shiffman et al, up to 38% of patients that underwent BS develop cholelithiasis after 6 months, and 41% of these patients become symptomatic 5,6. Endoscopic retrograde cholangiopancreatography (ERCP) is often indicated because of the increased risk of biliary diseases from either underlying obesity or postsurgical rapid weight loss 2,4…”