Laparoscopic-assisted ERCP and EUS in patients with prior Roux-en-Y gastric bypass surgery: a dual-center case series experience

Bowman, Erik; Greenberg, Jacob A.; Garren, Michael; Guda, Nalini M.; Rajca, Brian; Benson, Mark; Pfau, Patrick R.; Soni, Anurag; Walker, Andrew; Gopal, Deepak V.

doi:10.1007/s00464-016-4746-8

Cited by 33 publications

(15 citation statements)

References 16 publications

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“…The therapeutic success rate of peroral endoscopic ERCP is very low (59%) using either a pediatric colonoscope or device-assisted ERCP because of adhesion formation, angulation of the jejunojejunal anastomosis, and figure-eight looping of the scope[3,4]. New and challenging techniques in the performance of ERCP are endoscopic ultrasonography (EUS)-guided biliary drainage (EUS-BD) and laparoscopic-assisted transgastric ERCP (LA-ERCP), which have high success rates of 80%-100%[5-7].…”

Section: Introductionmentioning

confidence: 99%

Current status of endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy

Krutsri¹,

Kida²,

Yamauchi³

et al. 2019

WJG

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Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy must be performed by a highly experienced endoscopist. The challenges are accessing the afferent limb in different types of reconstruction, cannulating a papilla with a reverse orientation, and performing therapeutic interventions with uncommon endoscopic accessories. The development of endoscopic techniques has led to higher success rates in this group of patients. Device-assisted ERCP is the endoscopic procedure of choice for high success rates in short-limb reconstruction; however, these success rate is lower in long-limb reconstruction. ERCP assisted by endoscopic ultrasonography is now popular because it can be performed independent of the limb length; however, it must be performed by a highly experienced and skilled endoscopist. Stent deployment and small stone removal can be performed immediately after ERCP assisted by endoscopic ultrasonography, but the second session is needed for other difficult procedures such as cholangioscopy-guided electrohydraulic lithotripsy. Laparoscopic-assisted ERCP has an almost 100% success rate in long-limb reconstruction because of the use of a conventional side-view duodenoscope, which is compatible with standard accessories. This requires cooperation between the surgeon and endoscopist and is suitable in urgent situations requiring concomitant cholecystectomy. This review focuses on the advantages, disadvantages, and outcomes of various procedures that are suitable in different situations and reconstruction types. Emerging new techniques and their outcomes are also discussed.

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Section: Introductionmentioning

confidence: 99%

Current status of endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy

Krutsri¹,

Kida²,

Yamauchi³

et al. 2019

WJG

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“…Upper endoscopy is a minimally invasive approach that is considered a first-line approach for the diagnosis and treatment of upper gastrointestinal bleeding, anastomotic leak, or remnant gastritis in these patients [ 1 , 3 ]. Options to address bleeding or perforated ulcers after RYGB include oversewing with omental patch, remnant gastrectomy, or percutaneous transgastric endoscopy [ 3 , 9 ]. In this case, we successfully accessed the remnant segment via EDGE procedure.…”

Section: Discussionmentioning

confidence: 99%

Bile Leak following Laparoscopic Cholecystectomy due to Perforated Duodenal Ulcer in Patient with Roux-en-Y Gastric Bypass

Marsh

Almousa

Genuit

et al. 2021

Case Reports in Surgery

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Perforated ulcers of the excluded stomach or duodenum are exceedingly rare in patients who have undergone Roux-en-Y gastric bypass surgery. The diagnosis of perforated ulcer after Roux-en-Y gastric bypass remains challenging as there is often absence of free air or contrast extravasation from the biliopancreatic limb. We present a patient with signs and symptoms of acute cholecystitis. Laparoscopic cholecystectomy was complicated by postoperative bile leak. EDGE procedure was performed to access the remnant stomach and endoscopic evaluation revealed a perforated ulcer in the posterior duodenal bulb. Although unusual, in patients with bariatric surgery and upper abdominal pain, differential diagnosis including perforated ulcer of the biliopancreatic limb must be considered and early surgical exploration is essential.

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“…Recently, there has been progressive interest in accessing the excluded stomach laparoscopically for placement of a port to facilitate transgastric ERCP. [2][3][4] Here, we discuss the details of a representative case involving a patient who was treated effectively with this technique, as well as the results of 10 similar cases, of whom all but one were managed successfully.…”

Section: Laparoscopic-assisted Endoscopic Retrograde Cholangiopancreaticography After Roux-en-y Gastric Bypassmentioning

confidence: 99%

Laparoscopic-Assisted Endoscopic Retrograde Cholangiopancreaticography after Roux-en-Y Gastric Bypass

Friedman¹,

Connor²,

Coté³

et al. 2016

The American Surgeon

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Brief Reports should be submitted online to www.editorialmanager.com/ amsurg. (See details online under ''Instructions for Authors''.) They should be no more than 4 double-spaced pages with no Abstract or sub-headings, with a maximum of four (4) references. If figures are included, they should be limited to two (2). The cost of printing color figures is the responsibility of the author.In general, authors of case reports should use the Brief Report format.

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Laparoscopic-assisted ERCP and EUS in patients with prior Roux-en-Y gastric bypass surgery: a dual-center case series experience

Abstract: LA-ERCP and combined LA-EUS plus LA-ERCP are safe and highly successful diagnostic and therapeutic modalities for a wide variety of pancreatobiliary ailments in RYGB patients.

Cited by 33 publications

References 16 publications

Current status of endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy

Current status of endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy

Bile Leak following Laparoscopic Cholecystectomy due to Perforated Duodenal Ulcer in Patient with Roux-en-Y Gastric Bypass

Laparoscopic-Assisted Endoscopic Retrograde Cholangiopancreaticography after Roux-en-Y Gastric Bypass

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