ERCP via gastrostomy vs. double balloon enteroscopy in patients with prior bariatric Roux-en-Y gastric bypass surgery

Choi, Eun Kwang; Chiorean, Michael; Coté, Gregory A.; Hajj, Ihab I. El; Ballard, Darren D.; Fogel, Evan L.; Watkins, James L.; McHenry, Lee; Sherman, Stuart; Lehman, Glen A.

doi:10.1007/s00464-013-2850-6

Cited by 93 publications

(92 citation statements)

References 22 publications

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“…In 1998, access was made for the first time by gastrostomy exclusively made for this purpose [37], in a patient with Roux-en-Y for the treatment of obesity. Subsequent studies reaffirmed the feasibility and efficacy of the procedure, with success rates varying from 97% to 100% when considering papilla catheterization and post-catheterization interventions [38][39][40][41][42]. The possibility of access to the bile duct by means of the creation of an ostomy, by means of laparoscopic or percutaneous puncture (through the use of interventional radiology techniques), in the excluded part of the stomach, allows the use of a duodenoscope in a conventional way, allowing the unrestricted use of accessories to perform ERCP.…”

Section: Discussionmentioning

confidence: 94%

Approach of the Bile Duct by Gastrostomy in Patients With Bypass in Roux-en-Y Proved to Be Safe and Effective

et al. 2017

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Background: The prevalence and increase of obesity in the world are that 2.3 billion adults were overweight and 700 million adults were obese in 2015. In the context of the morbid obesity pandemic, bariatric surgery was presented as a gold standard treatment. It is known that the prevalence of cholelithiasis is 3 to 4 times higher in morbidly obese patients when compared to the general population. Literature reports that the first attempts to approach the biliary tract in patients with gastric bypass in Roux-en-Y, were performed transorally and had resulted in low success rates. The aim of this study was to analyze the results of the use of the endoscopic transgastrostomy technique for the treatment of biliary tract diseases in patients submitted to Yde-Roux bypass.

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Section: Discussionmentioning

confidence: 94%

Approach of the Bile Duct by Gastrostomy in Patients With Bypass in Roux-en-Y Proved to Be Safe and Effective

et al. 2017

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“…A multicenter study by Siddiqui et al performed ERCPs in 39 RYGB patients using the 'short' double balloon enteroscope (EC-450BI5; Fujinon), achieving successful bile duct cannulation in 29 of the 32 patients in whom the papilla/surgical anastomoses was reached.A full spectrum of therapeutic maneuvers was performed, including sphincterotomy, stone extraction, balloon dilation, and the insertion of plastic/metal stents [20][21][22][23][24][25].Additionally, studies have been done by Moreels et al [22] and Patel et al [26] demonstrating the feasibility of diagnostic and therapeutic DBE-ERCP in large cohorts of patients who had undergone a variety of of Roux-en-Y reconstructive surgeries.These studies along with others are summarized in Table 2.…”

Section: Dbe-ercpmentioning

confidence: 99%

“…The success rate of DBE-ERCP according to them was much lower for pancreatic indication compared with biliary indication. Along parallel lines Choi et al opined that DBE-ERCP had a reasonable success rate for managing biliary stone disease but did not adequately address Sphincter of Oddi Dysfunction (SOD) and pancreatic diseases [24]. Note must also be made of the possible advantages afforded by the short DBE system namely better maneuverability, effective pressure application to the enteroscope (increasing the likelihood of reaching the papilla or anastomosis, and allowing the use of commercially available ERCP cannulas), and the use of instruments to intervene therapeutically-benefits which clearly improved the overall success rate/yields in those respective studies.…”

Section: Dbe-ercpmentioning

confidence: 99%

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The Role of Overtube-assisted Deep Enteroscopy ERCP in Roux-en-Y Gastric Bypass Patients

Ali¹,

Ahmed²,

Iqbal³

2014

J Obes Weight Loss Ther

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Bariatric surgery is the fastest growing medical intervention for obesity performed in theUS and Roux-en-Y Gastric Bypass (RYGB), is considered the "gold standard"comprising more than 60% of these cases. However, patients with surgically alteredanatomy after undergoing RYGB pose serious challenges to the endoscopist whenaccess to the biliary or pancreatic systems is required. Hurdles include reaching themajor papilla after navigating the length of the roux limb (often >100 cm) given thelimitations of standard gastroscopes and even push enteroscopes in achievingsufficient depth of insertion, orientation (upside-down configuration of the papilla), andthe lack of accessories that are actually designed for the long endoscopes required forperforming ERCPs in this patient population.To work around the aforementioned problems-specifically the length of the Rouxlimb-innovative techniques, notably overtube systems have been developed to allowthe enteroscope to reach the ampulla and perform ERCP. Three overtube-systems arepresently available: Double-balloon Enteroscopy (DBE), Single-balloon Enteroscopy(SBE), and Spiral Enteroscopy (SE). This review is designed to describe the role of these 3overtube systems in assisting with ERCP in RYGB patients based on existing literatureand evaluate their success rates in reaching the ampulla, diagnostic & therapeuticyields, and complication rates.Our review shows good success rates when comparing ability to reach ampulla (DBEERCP:83%; SBE-ERCP: 71%; SE-ERCP: 70%), diagnostic (DBE-ERCP: 77%; SBEERCP:55%; SE-ERCP: 41%) and therapeutic yields (DBE-ERCP: 75%; SBE-ERCP:81%; SE-ERCP: 68%) with low complication rates for all three systems.The sheer volume of RYGB procedures being performed and the associated predictedincrease in complications will lead to advanced endoscopists encountering morepatients with surgically altered anatomy and our review provides evidence thatovertube-assisted systems are effective and safe, and should be considered as a firstline modality in RYGB patients requiring ERCP.

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“…Most of the above procedures have are associated with complication rates ranging from 0% to 17% and low success rate in terms of CBD cannulation (6). Compared with other techniques, success rate with LTERCP is above 90% (7,8).…”

mentioning

confidence: 99%

A tough scope to swallow: endoscopic retrograde cholangiopancreatography through percutaneous endoscopic gastrostomy

Amjad

Hussain

Ullah

et al. 2018

Turk J Gastroenterol

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We are presenting a case of oral cancer with choledocholithiasis that was successfully treated with transgastric endoscopic retrograde cholangiopancreatography (ERCP). A 76-year-old female with past medical history of squamous cell cancer of the oral cavity status post hemiglossectomy with left anterolateral free flap, bilateral neck dissections, tracheostomy, and decannulation with gastrostomy tube placement, chemotherapy and radiation therapy presented with epigastric pain for 5 days. She experienced pain was radiating to the right upper quadrant and right flank, which was associated with nausea. Her vital signs were stable. Abdominal examination showed positive Murphy's sign; 18-French (Fr) gastrostomy tube was present in left upper quadrant.Laboratory tests revealed normal white blood cell count, with mildly elevated liver enzyme levels as follows: aspartate transaminase, 70 U/L; alanine transaminase, 105 U/L; alkaline phosphatase, 325 U/L; total bilirubin, 4.3 mg/dL; and direct bilirubin, 3.8 mg/dL. Computed tomography (CT) of the abdomen and pelvis revealed irregular gall bladder wall thickening, large calcified gall stones, intra and extra hepatic biliary duct dilation, and common bile duct diameter of 1.1 cm. An endoscope (Olympus) was inserted via the oral route, but the esophageal lumen could not be visualized. Subsequently, an adult endoscope was inserted through the gastrostomy. The insertion of scope was resistance-free. On retrograde view, the gastroesophageal junction was visualized and the view of upper esophagus was totally obstructed. Rendezvous procedure was attempted to reestablish the lumen connection from the esophagus to the hypopharynx but was unsuccessful. The scope was advanced to the duodenum, and the ampulla was visualized. An 18×20-mm esophageal stent (Cook Evolution fully covered stent) was advanced to the stomach with the help of previously placed guide wire under fluoroscopic visualization (Figure 1), 18-20-mm balloon dilator was inserted through the stent, and dilation was performed. A duodenoscope was inserted with gentle pressure and passed through the stent; the scope was advanced to the duodenum. A blush of bile and pus and the ampulla were identified. Biliary cannulation was performed using the wire-guided technique. Cholangiogram revealed a large stone at the cystic duct and a smaller filling defect at the distal common bile duct (CBD) ( Figure 2). Sphincterotomy was performed, and a 12-15-mm extractor balloon was advanced over the guidewire into the biliary tree. Balloon sweeps were performed, and a large stone was removed. Contrast, bile, and pus were draining from the biliary tree. Multiple balloon sweeps were performed, and the balloon could sweep through the papilla without resistance. An occlusion cholangiogram showed that the cystic duct stone had migrated toward the gallbladder. The balloon was removed, and a 10-F×9-cm plastic stent was placed into the CBD over the guidewire. The duodenoscope was withdvrawn. A 38-Fr gastrostomy tube (Malecot tube) was then placed t...

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ERCP via gastrostomy vs. double balloon enteroscopy in patients with prior bariatric Roux-en-Y gastric bypass surgery

Abstract: GERCP is more effective than DBERCP in gaining access to the pancreatobiliary tree in patients with RYGB, but it is hindered by the gastrostomy maturation delay and a higher morbidity. Technical improvements in each method are needed.

Cited by 93 publications

References 22 publications

Approach of the Bile Duct by Gastrostomy in Patients With Bypass in Roux-en-Y Proved to Be Safe and Effective

Approach of the Bile Duct by Gastrostomy in Patients With Bypass in Roux-en-Y Proved to Be Safe and Effective

The Role of Overtube-assisted Deep Enteroscopy ERCP in Roux-en-Y Gastric Bypass Patients

A tough scope to swallow: endoscopic retrograde cholangiopancreatography through percutaneous endoscopic gastrostomy

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