Laparoscopy-assisted ERCP (LA-ERCP) following bariatric gastric bypass surgery: initial experience of a single UK centre

Paranandi, Bharat; Joshi, Deepak; Mohammadi, Borzoueh; Jenkinson, Andrew; Adamo, Marco; Read, Samantha; Johnson, Gavin; Chapman, Michael H.; Pereira, Stephen P.; Webster, George

doi:10.1136/flgastro-2015-100556

Cited by 19 publications

(18 citation statements)

References 18 publications

(12 reference statements)

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“…Cannulation of the duodenal papilla is obtained in almost all cases (89-100%) 3 , 6 , 7 , 8 , 14 , 17 , 21 , which was also found in the present study, with 100% success of the technique. In addition, the gastrostomy route is superior to the technique of double balloon enteroscopy 7 , 12 , since it has no lateral vision, making it difficult to canalize the papilla and doing therapeutic procedures.…”

Section: Discussionsupporting

confidence: 88%

“…Laparoscopic assisted ERCP has been a good alternative for the approach of patients after bariatric surgery with Roux-en-Y reconstruction. The main indications are the classic ones reported in the literature 3 , 6 , 7 , 8 , 14 , 17 , 19 . The seven patients who were treated by trans-gastric ERCP after Roux-en-Y gastric bypass had choledocholithiasis confirmed by some imaging examination.…”

Section: Discussionmentioning

confidence: 86%

“…There are several therapeutic possibilities that can be performed after adequate visualization of the papilla 3 , 6 , 7 , 8 , 14 , 17 , 21 . In addition, because videolaparoscopy is realized, it is possible to diagnose and correct internal hernias, and also to perform cholecystectomy in the same procedure 16 .…”

Section: Discussionmentioning

confidence: 99%

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

Ivano

Ponte

Dubik

et al. 2019

ABCD, arq. bras. cir. dig.

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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.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 86%

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

Ivano

Ponte

Dubik

et al. 2019

ABCD, arq. bras. cir. dig.

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“…Overall, four studies [15][16][17]35] provided data on EDGE, 18 studies [11,33,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] provided data on LA-ERCP, and five studies [35,44,49,52,53] provided information on BE-ERCP for our analysis.…”

Section: Search Results and Population Characteristicsmentioning

confidence: 99%

EDGE in Roux-en-Y gastric bypass: How does it compare to laparoscopy-assisted and balloon enteroscopy ERCP: a systematic review and meta-analysis

et al. 2020

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Background and study aims Endoscopic ultrasound-directed transgastric ERCP (EDGE) is a new endoscopic procedure to perform ERCP in Roux-en-y gastric bypass (RYGB) patients. The aim of this study was to conduct a systematic review and meta-analysis to evaluate technical success, clinical success and adverse effects of EDGE and compare it to laparoscopic ERCP (LA-ERCP) and balloon ERCP (BE-ERCP). Patients and methods We conducted a comprehensive search of several databases and conference proceedings including PubMed, EMBASE, Google-Scholar, LILACS, SCOPUS, and Web of Science databases to identify studies reporting on EDGE, LA-ERCP, and BE-ERCP. The primary outcome was to evaluate technical and clinical success of all three procedures and the secondary analysis focused on calculating the pooled rate of all adverse events (AEs), along with the commonly reported AE subtypes. Results Twenty-four studies on 1268 patients were included in our analysis with the majority of the population being males with mean age 53.72 years. Pooled rates of technical and clinical success with EDGE wer 95.5 % and 95.9 %, with LA-ERCP were 95.3 % and 92.9 % and were BE-ERCP were 71.4 % and 58.7 %, respectively. Pooled rates of all AEs with EDGE were 21.9 %, with LA-ERCP 17.4 % and with BE-ERCP 8.4 %. Stent migration was the most common AE with EDGE with 13.3 % followed by bleeding with 6.6 %. Conclusion Our meta-analysis demonstrated that the technical and clinical success of EDGE procedure is better than BE-ERCP and comparable to that of LA-ERCP in RYGB patients. EDGE also has a similar safety profile as compared to LA-ERCP but has higher AE rate as compared to BE-ERCP.

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“…Furthermore, sometimes the previous operative report of the RYGB surgery might not detail the technique used, post-operative complication or the anatomy and length of the roux as well as pancreatico-biliary limb [7][8][9][10]. The disadvantages of surgery-assisted ERCP are that it involves surgery and that it may take time for the surgeon to identify the gastric remnant due to the altered anatomy from previous surgery in these patients [11][12][13]. Table 1 summarize the advantages and disadvantages of LA-ERCP.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopy Assisted ERCP

Alhashimalsayed¹,

Hayaf²,

Joy³

2017

GHOA

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Laparoscopy Assisted ERCPSubmit Manuscript | http://medcraveonline.com obesity trend suggests that by 2025, the prevalence of obesity worldwide will reach 18% for males and surpass 21% in women [1]. The trend of obesity in the Middle East is particularly pronounced and exceeds 50% among women in many countries in this region. Bariatric surgery has been found to be effective for weight loss and reduce the consequences of obesity.However, long term health consequences of bariatric surgery are not fully clear. The weight loss that accompanies bariatric Roux-en-Y gastric bypass (R-e-YGB) is a risk factor for cholelithiasis which in turn increases the risk of choledocholithiasis and gall stone pancreatitis. Around 7-8% of post R-e-YGB patients become symptomatic with gall stone disease that require cholecystectomy. Therefore, due to this relative low prevalence rate of gall stone disease, recommending prophylactic cholecystectomy in patients undergoing R-e-YGB might be an overkill and is not generally advocated [1]. While performing cholecystectomy in R-e-YGB patients is relatively straightforward, performing Endoscopic Retrograde Cholangiopancreatography (ERCP) with conventional scope is technically challenging in these cases.We report a case of laparoscopically-assisted ERCP with review of the literature. Case ReportA 30-year-old woman status post R-e-YGB surgery for obesity 4 years ago. She was admitted with acute gall stone pancreatitis. Biliary imaging confirmed choledocholithiasis and cholelithiasis. ERCP was attempted using a conventional colonoscope under conscious sedation using midazolam and fentanyl. However, despite entering the pancreatico-biliary limb (roux limb) of the intestine and visualizing bile, this was not successful in identifying the ampulla. This procedure took around 2 hours and had to be abandoned.She later underwent Laparoscopy with assisted ERCP and subsequent cholecystectomy. The patient had standard laparoscopy for access into the peritoneal cavity. After identification of the gastric remnant, the therapeutic duodenoscope was introduced into the abdominal cavity via left upper quadrant incision and inserted into the remnant stomach through the gastrostomy. It was passed into the duodenum with access to the ampulla without difficulties. The common bile duct was cannulated using guide wire. Cholangiogram reveled stones in the common bile duct which were extracted after sphincterotomy with balloon. It was an uncomplicated procedure. The total operative time was 100 minutes. The patient was discharged the next day with good recovery. The patient was reviewed a month later and was asymptomatic.There were no real difficulties in manipulating the duodenoscope. There were no ERCP related complications. The postoperative care was similar to conventional cholecystectomy or other laparoscopy procedures. There was close collaboration between the surgeon and the endoscopist to harmonize their timetable and to ensure optimal positioning of the endoscopic and radiological equipment during the procedur...

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Laparoscopy-assisted ERCP (LA-ERCP) following bariatric gastric bypass surgery: initial experience of a single UK centre

Cited by 19 publications

References 18 publications

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

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

EDGE in Roux-en-Y gastric bypass: How does it compare to laparoscopy-assisted and balloon enteroscopy ERCP: a systematic review and meta-analysis

Laparoscopy Assisted ERCP

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