Laparoscopy–assisted versus balloon enteroscopy–assisted ERCP in bariatric post–Roux-en-Y gastric bypass patients

Schreiner, Mitchal A.; Chang, Lily; Glück, Michael; Irani, Shayan; Gan, S. Ian; Brandabur, John J.; Thirlby, Richard C.; Moonka, Ravi; Kozarek, Richard A.; Ross, Andrew

doi:10.1016/j.gie.2011.11.019

Cited by 222 publications

(155 citation statements)

References 17 publications

(18 reference statements)

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“…However, the adverse event rate is up to 13% and this procedure requires coordination of multiple teams, leading to increased costs. 42,43 The EUS-directed transgastric ERCP (EDGE) procedure utilizes EUS to visualize the bypassed stomach, then create a fistulous tract with a LAMS, and perform ERCP through the LAMS.…”

Section: Eus-directed Transgastric Ercpmentioning

confidence: 99%

Lumen apposing metal stents: A review of current uses and outcomes

Bank

Adler

2017

Int J Gastrointest Interv

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A B S T R A C TLumen-apposing metal stents (LAMS) represent a new innovation in gastrointestinal endoscopy. These devices have a saddle-shaped design and larger inner lumen diameter than either plastic or metal biliary stents, which should decrease the risk of migration and allows for an endoscope to pass into pancreatic fluid collections as well as the ability to perform direct endoscopic necrosectomy. LAMS were originally conceived and designed for transmural pancreatic fluid collection drainage but are currently also being used for many off label indications. There are three different LAMS available at this time around the globe. This manuscript will review the current state of the art with regards to LAMS and their indications, usage, and outcomes.

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Section: Eus-directed Transgastric Ercpmentioning

confidence: 99%

Lumen apposing metal stents: A review of current uses and outcomes

Bank

Adler

2017

Int J Gastrointest Interv

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“…The success rate of enteroscopy assisted ERCP does significantly drop if the roux enteral limb length is above 150 cm (25% compared to 88% in patient with shorter roux limb). 7 It is important to note the availability of limited ERCP devices compatible with enteroscopes of 200-cm length. The short DBE with a working length of 152 cm allows the use of standard ERCP accessories and thus may prove to be extremely useful.…”

Section: Enteroscopy Assisted Ercpmentioning

confidence: 99%

“…1 Furthermore, this procedure has been shown to cost beneficial inpatient with long roux limb > 150 cm. 7 In order to circumvent the inconvenience of coordinating with surgeons and performing procedure in un-familiar territory, Baron 12 reported DBE assisted retrograde placement of a percutaneous endoscopic gastrostomy (PEG) to allow subsequent ERCP in a patient with a long-limb RYGB. Thompson et al 13 have further demonstrated a single session ERCP approach by EUS-guided percutaneous gastric access.…”

Section: Surgically Assisted Trans-gastric Ercpmentioning

confidence: 99%

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Endoscopic retrograde cholangiopancreatography in surgically altered anatomy

Goyal

Kasapoğlu

Thosani

2017

Int J Gastrointest Interv

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Endoscopic retrograde cholangiopancreatography (ERCP) in a surgically altered anatomy is a technically challenging undertaking with variable success and adverse event rates. There are several potential challenges to successfully perform an ERCP in patients with surgically altered anatomy such as identification of afferent limb, accessing and visualization of the papilla, and selective cannulation of the biliary and pancreatic ducts from altered orientation of the papilla. Several strategies to improve the success rate have been recommended by various endoscopy experts. In this review, we discussed the published literature involving various ERCP techniques described for surgically altered anatomies.

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“…Similarly, studies like that undertaken by Schreiner et al have looked at RYGB patients who underwent Laparoscopy-assisted (LA) as opposed to Balloon Enteroscopy-assisted (BEA) ERCP [36]. BEA included single-and double-balloon enteroscopy.…”

Section: Comparativementioning

confidence: 99%

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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Laparoscopy–assisted versus balloon enteroscopy–assisted ERCP in bariatric post–Roux-en-Y gastric bypass patients

Cited by 222 publications

References 17 publications

Lumen apposing metal stents: A review of current uses and outcomes

Lumen apposing metal stents: A review of current uses and outcomes

Endoscopic retrograde cholangiopancreatography in surgically altered anatomy

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

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