Laparoscopic transcystic common bile duct exploration versus transgastric endoscopic retrograde cholangiography during cholecystectomy after Roux-en-Y gastric bypass

Zaigham, Hassan; Enochsson, Lars; Ottosson, Johan; Regnér, Sara

doi:10.1016/j.soard.2023.01.023

Cited by 3 publications

(6 citation statements)

References 23 publications

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“…Roux‐en‐Y gastric bypass has the disadvantage that the biliary tree will be detached from the orally accessible gastroduodenal pathway, which limits the interventions at the biliary tree through endoscopy, that is endoscopic retrograde cholangiopancreatographies (ERCP). However, transgastric ERCP supported by laparoscopy could be one option if biliary complications occur after LT and gastric bypass instead of sleeve gastrectomy 65 …”

Section: Discussionmentioning

confidence: 99%

“…However, transgastric ERCP supported by laparoscopy could be one option if biliary complications occur after LT and gastric bypass instead of sleeve gastrectomy. 65 The main limitation of this study appears with the well-known methodologic bias of internet-based surveys. For example, the survey respondents participated on a voluntary basis, which mirrors a form of selection bias (volunteer effect).…”

Section: Transplant Surgeonsmentioning

confidence: 95%

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How best to combine liver transplantation and bariatric surgery?—Results from a global, web‐based survey

Widmer,

Eden,

Abbassi

et al. 2023

Liver International

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Background and AimsObesity is a growing healthcare challenge worldwide and a significant risk factor for liver failure as seen with non‐alcoholic steatohepatitis (NASH). Combining metabolic‐bariatric surgery (MBS) with liver transplantation (LT) appears as attractive strategy to treat both, the underlying liver disease and obesity. However, there is an ongoing debate on best timing and patient selection. This survey was designed to explore the current treatment practice for patients with NASH and obesity worldwide.MethodsA web‐based survey was conducted in 2022 among bariatric and LT surgeons, and hepatologists from Europe, North and South America and Asia.ResultsThe survey completion rate was 74% (145/196). The average respondents were 41–50 years (38%), male (82.1%) and had >20 years of clinical experience (42.1%). Centres with a high LT‐caseload for NASH were mainly located in the USA and United Kingdom. Almost 30% have already performed a combination of LT with MBS and 49% plan to do it. A majority of bariatric surgeons prefer MBS before LT (77.2%), whereas most of LT surgeons (52%) would perform MBS during LT. Most respondents (n = 114; 80%) favour sleeve gastrectomy over other bariatric techniques. One third (n = 42; 29.4%) has an established protocol regarding MBS for LT candidates.ConclusionThe most experienced centres doing LT for NASH are in the USA and United Kingdom with growing awareness worldwide. Overall, a combination of MBS and LT has already been performed by a third of respondents. Sleeve gastrectomy is the bariatric technique of choice—preferably performed either before or during LT.

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Section: Discussionmentioning

confidence: 99%

Section: Transplant Surgeonsmentioning

confidence: 95%

How best to combine liver transplantation and bariatric surgery?—Results from a global, web‐based survey

Widmer,

Eden,

Abbassi

et al. 2023

Liver International

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“…Alternative treatments for patients with Roux-en-Y reconstruction are percutaneous transhepatic access to the bile ducts, endoscopic ultrasound directed transgastric cholangiography, 32 laparoscopic transgastric ERC 33 or balloon endoscopy-assisted ERC. Those interventions are likely related to a higher peri-interventional morbidity and burden for the patient than a transcystic antegrade balloon spincteroplasty during cholecystectomy.…”

Section: Discussionmentioning

confidence: 99%

“…Those interventions are likely related to a higher peri-interventional morbidity and burden for the patient than a transcystic antegrade balloon spincteroplasty during cholecystectomy. Zaigham et al 33 compared laparoscopic transcystic common bile duct exploration to transgastric endoscopic retrograde cholangiography in patients with a history of a Roux-en-Y gastric bypass showing similar success rates and an acceptable morbidity for both interventions (adverse events of 16% vs. 18% within 30 days). In contrast to the technique presented here, these investigators used a transcystic cholangioscopic approach.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and safety of intraoperative bile duct clearance by antegrade transcystic balloon sphincteroplasty: A prospective observational pilot study

Prevost,

Huber,

Schnell

et al. 2023

J Trauma Acute Care Surg

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Background Concomitant cholecysto- and choledocholithiasis is common. Standard treatments are endoscopic retrograde cholangiography (ERC) followed by cholecystectomy or laparoendoscopic rendez-vous. ERC has drawbacks such as post-ERC-pancreatitis or -bleeding and potentially more than one intervention is required to address common bile duct (CBD) stones. Safety and feasibility of an intraoperative antegrade transcystic single-stage approach during cholecystectomy with balloon sphincteroplasty and pushing of stones to the duodenum has not been evaluated prospectively. The aim of this pilot study was to evaluate this procedure regarding safety, feasibility, and stone clearance rate. Methods Prospective single centre intervention study (IDEAL stage 2b). Main inclusion criteria was confirmed choledocholithiasis (stones ≤6 mm) at intraoperative cholangiography. Success of the procedure was defined as CBD stone clearance at intraoperative control cholangiography, absence of symptoms and no elevated cholestasis parameters at 6 weeks follow up. Simon’s two stage design was used to determine sample size. Results From 1/2021-4/2022, a total of 57 patients fulfilled the final inclusion criteria and were included. Mild pancreatitis or cholangitis were present upon admission in 15 (26%) and 15 (26%) patients, respectively. Median number of CBD-stones was 1 (1-6). Median stone diameter was 4 mm (0.1-6 mm). CBD stone clearance was achieved in 54 patients (94%). The main reason for failed CBD clearance was the inability to push the guidewire along the biliary stone into the duodenum. Median intervention time was 28 min (14-129 min). While there was no postoperative pancreatitis, two patients (3.5%) had asymptomatic hyperlipasaemia four hours postoperatively. Conclusions Intraoperative CBD stone clearance by antegrade balloon sphincteroplasty appears to be safe and highly feasible. Its overall superiority to the current standards warrants evaluation by a randomized controlled trial. Level of Evidence V, therapeutic/care management

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“…In patients with RYGB anatomy, balloon enteroscopy ERCP (BE-ERCP) had a lower technical success rate of 71.4%, while EDGE and LTCBDE had a similar rate of 95.5% and 90,9% respectively [ 12 , 48 ]. However, LTCBDE can be limited by the size of the bile duct stone more commonly being used with stones < 4 mm and less frequently in stones > 8 mm [ 49 ]. Da Ponte-Neto postulates that the high success rates of LA-ERCP are due to firstly, the use of standard duodenoscopes allowing for better tangential visualization of the papilla and use of other appropriate ERCP accessories, and secondly due to the use of an elevator allowing for better access to the papilla, both of which are not used in balloon enteroscopy-based techniques [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of LA-ERCP procedure following Roux-en-Y gastric bypass: a systematic review and meta-analysis

et al. 2023

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Introduction Rapid weight loss following Roux-en-Y gastric bypass surgery (RYGB) translates to an increased need for endoscopic retrograde cholangiopancreatography (ERCP) intervention. Laparoscopically Assisted Transgastric ERCP (LA-ERCP) has emerged to address the issue of accessing the excluded stomach. This study aims to evaluate the safety and efficacy of LA-ERCP procedure following RYGB. Methods The Cochrane, EMBASE, SCOPUS, MEDLINE, Daily and Epub databases were searched from inception to May 2022 using the PRISMA guidelines. Eligible studies reported participants older than 18 years who underwent the LA-ERCP procedure, following RYGB, and outcomes of patients. Results 27 unique studies met the inclusion criteria with 1283 patients undergoing 1303 LA-ERCP procedures. 81.9% of the patients were female and the mean age was 52.18 ± 13.38 years. The rate of concurrent cholecystectomy was 33.6%. 90.9% of procedures were undertaken for a biliary indication. The mean time between RYGB and LA-ERCP was 89.19 months. The most common intervention performed during the LA-ERCP was a sphincterotomy (94.3%). Mean total operative time was 130.48 min. Mean hospital length of stay was 2.697 days. Technical success was 95.3%, while clinical success was 93.8%. 294 complications were recorded with a 20.6% complication rate. The most frequent complications encountered were pancreatitis (6.8%), infection (6.1%), bleeding (3.4%), and perforation (2.5%). Rate of conversion to open laparotomy was 7%. Conclusion This meta-analysis presents preliminary evidence to suggest the safety and efficacy of LA-ERCP procedure following RYGB. Further investigations are warranted to evaluate the long-term efficacy of this procedure using studies with long-term patient follow-up.

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Laparoscopic transcystic common bile duct exploration versus transgastric endoscopic retrograde cholangiography during cholecystectomy after Roux-en-Y gastric bypass

Cited by 3 publications

References 23 publications

How best to combine liver transplantation and bariatric surgery?—Results from a global, web‐based survey

How best to combine liver transplantation and bariatric surgery?—Results from a global, web‐based survey

Feasibility and safety of intraoperative bile duct clearance by antegrade transcystic balloon sphincteroplasty: A prospective observational pilot study

Safety and efficacy of LA-ERCP procedure following Roux-en-Y gastric bypass: a systematic review and meta-analysis

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