Management of choledocholithiasis after Roux-en-Y gastric bypass: a systematic review and pooled proportion meta-analysis

Connell, Matthew; Sun, Warren; Mocanu, Valentin; Dang, Jerry; Kung, Janice Y.; Switzer, Noah; Birch, Daniel W.; Karmali, Shahzeer

doi:10.1007/s00464-022-09018-y

Cited by 18 publications

(15 citation statements)

References 54 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thanks to the excluded stomach in RYGB, multiple alternative approaches currently exist, including laparoscopy-assisted ERCP, endoscopic ultrasound (EUS)-directed transgastric ERCP, EUS-guided intrahepatic puncture with antegrade clearance, and percutaneous transhepatic biliary drainage [288,289]. Both laparoscopy-assisted ERCP and EUS-directed transgastric ERCP have high (> 90 %) procedural success rates but also higher adverse event rates (12 %-24 %) [290]. Also, in patients with Whipple's pancreaticoduodenectomy, transgastric EUS-guided drainage of the pancreatic duct is feasible with a good technical success rate of more than 70 %, but with an adverse event rate of 20 %-35 % [291,292].…”

Section: Dae-ercp In Patients With Altered Anatomymentioning

confidence: 99%

Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022

et al. 2022

View full text Add to dashboard Cite

Main Recommendations MR1 ESGE recommends small-bowel capsule endoscopy as the first-line examination, before consideration of other endoscopic and radiological diagnostic tests for suspected small-bowel bleeding, given the excellent safety profile of capsule endoscopy, its patient tolerability, and its potential to visualize the entire small-bowel mucosa.Strong recommendation, moderate quality evidence. MR2 ESGE recommends small-bowel capsule endoscopy in patients with overt suspected small-bowel bleeding as soon as possible after the bleeding episode, ideally within 48 hours, to maximize the diagnostic and subsequent therapeutic yield.Strong recommendation, high quality evidence. MR3 ESGE does not recommend routine second-look endoscopy prior to small-bowel capsule endoscopy in patients with suspected small-bowel bleeding or iron-deficiency anemia.Strong recommendation, low quality evidence. MR4 ESGE recommends conservative management in those patients with suspected small-bowel bleeding and high quality negative small-bowel capsule endoscopy.Strong recommendation, moderate quality evidence. MR5 ESGE recommends device-assisted enteroscopy to confirm and possibly treat lesions identified by small-bowel capsule endoscopy.Strong recommendation, high quality evidence. MR6 ESGE recommends the performance of small-bowel capsule endoscopy as a first-line examination in patients with iron-deficiency anemia when small bowel evaluation is indicated.Strong recommendation, high quality evidence. MR7 ESGE recommends small-bowel capsule endoscopy in patients with suspected Crohn’s disease and negative ileocolonoscopy findings as the initial diagnostic modality for investigating the small bowel, in the absence of obstructive symptoms or known bowel stenosis.Strong recommendation, high quality evidence. MR8 ESGE recommends, in patients with unremarkable or nondiagnostic findings from dedicated small-bowel cross-sectional imaging, small-bowel capsule endoscopy as a subsequent investigation if deemed likely to influence patient management.Strong recommendation, low quality evidence. MR9 ESGE recommends, in patients with established Crohn’s disease, the use of a patency capsule before small-bowel capsule endoscopy to decrease the capsule retention rate.Strong recommendation, moderate quality evidence. MR10 ESGE recommends device-assisted enteroscopy (DAE) as an alternative to surgery for foreign bodies retained in the small bowel requiring retrieval in patients without acute intestinal obstruction.Strong recommendation, moderate quality evidence. MR11 ESGE recommends DAE-endoscopic retrograde cholangiopancreatography (DAE-ERCP) as a first-line endoscopic approach to treat pancreaticobiliary diseases in patients with surgically altered anatomy (except for Billroth II patients).Strong recommendation, moderate quality evidence.

show abstract

Section: Dae-ercp In Patients With Altered Anatomymentioning

confidence: 99%

Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Currently, the 2 most common and successful approaches for access to the ampulla are laparoscopic-assisted ERCP and endoscopic ultrasonography-directed transgastric ERCP (often referred to as the EDGE procedure) . The laparoscopic approach involves placement of a 15-mm port directly into the remnant stomach to allow for insertion of the endoscope for intraoperative ERCP.…”

Section: Discussion and Observationsmentioning

confidence: 99%

“…57 Currently, the 2 most common and successful approaches for access to the ampulla are laparoscopic-assisted ERCP and endoscopic ultrasonography-directed transgastric ERCP (often referred to as the EDGE procedure). 58 The laparoscopic approach involves placement of a 15-mm port directly into the remnant stomach to allow for insertion of the endoscope for intraoperative ERCP. The EDGE procedure is quickly replacing laparoscopic-assisted ERCP due to its entirely endoscopic approach, acceptable risk profile, and technical success rates in the 90% to 100% range.…”

Section: Biliary Diseasementioning

confidence: 99%

Abdominal Pain After Roux-en-Y Gastric Bypass

Fry,

Finks

2023

JAMA Surg

View full text Add to dashboard Cite

ImportanceRoux-en-Y gastric bypass (RYGB) remains one of the most commonly performed operations for morbid obesity and is associated with significant long-term weight loss and comorbidity remission. However, health care utilization rates following RYGB are high and abdominal pain is reported as the most common presenting symptom for those seeking care.ObservationsGiven the limitations of physical examination in patients with obesity, correct diagnosis of abdominal pain following RYGB depends on a careful history and appropriate use of radiologic, laboratory and endoscopic studies, as well as a clear understanding of post-RYGB anatomy. The most common etiologies of abdominal pain after RYGB are internal hernia, marginal ulcer, biliary disease (eg, cholelithiasis and choledocholithiasis), and jejunojejunal anastomotic issues. Early identification of the etiology of the pain is essential, as some causes, such as internal hernia or perforated gastrojejunal ulcer, may require urgent or emergent intervention to avoid significant morbidity. While laboratory findings and imaging may prove useful, they remain imperfect, and clinical judgment should always be used to determine if surgical exploration is warranted.Conclusions and RelevanceThe etiologies of abdominal pain after RYGB range from the relatively benign to potentially life-threatening. This Review highlights the importance of understanding key anatomical and technical aspects of RYGB to guide appropriate workup, diagnosis, and treatment.

show abstract

“…A more recent meta‐analysis comparing up to seven approaches (53 studies, n = 857 patients) showed lower rates of stone clearance with EA‐ERCP (61.5%) when compared to LA‐ERCP, EDGE, laparoscopic bile duct exploration, and percutaneous transhepatic biliary drainage. EA‐ERCP was furthermore characterized by a significantly longer procedure duration when compared to EDGE and LA‐ERCP (67.4 min vs. 133.1 min) 42 . Due its ease of use and the increasing supporting data, EDGE has found its way into the clinical guidelines, being suggested as an alternative in patients with RYBG, aimed at overcoming the invasiveness of LA‐ERCP and the technical limitations of EA‐ERCP 3…”

Section: Eus‐directed Transgastric Ercp (Edge)mentioning

confidence: 99%

“…EA-ERCP was furthermore characterized by a significantly longer procedure duration when compared to EDGE and LA-ERCP (67.4 min vs. 133.1 min). 42 Due its ease of use and the increasing supporting data, EDGE has found its way into the clinical guidelines, being suggested as an alternative in patients with RYBG, aimed at overcoming the invasiveness of LA-ERCP and the technical limitations of EA-ERCP. 3 In specific situations, current evidence suggests that one should favor one technique above the other.…”

Section: Outcomes and Indicationsmentioning

confidence: 99%

Endoscopic ultrasound‐guided gastrointestinal anastomosis: Current status and future perspectives

Bronswijk

Pérez-Cuadrado-Robles

Merwe

2022

Digestive Endoscopy

View full text Add to dashboard Cite

Objectives: Both clinical experience and supporting data have improved drastically in the context of endoscopic ultrasoundguided gastrointestinal anastomosis (EUS-GIA). Where outcomes used to be questioned, focus has now moved towards performing comparative studies, optimizing technical approaches, improving patient selection, and developing welldefined treatment algorithms. Methods:The purpose of this review is to provide an overview of technical developments within EUS-GIA and to discuss the current status of EUS-GIA and future directions.Results: EUS-GIA techniques such as EUS-guided gastroenterostomy (EUS-GE), EUS-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP) (EDGE) and EUSguided treatment afferent loop syndrome have undergone further development, refining technical approaches, improving patient selection and subsequent outcomes. Retrospective evaluations of EUS-GE have shown similar safety when compared to enteral stenting, whilst attaining surgical range efficacy. Whereas, in patients with gastric bypass anatomy, EDGE seems less cumbersome and time consuming than enteroscopy-assisted ERCP, while preventing surgical morbidity associated with laparoscopy-assisted ERCP. Although less evidence is available on EUS-guided treatment of afferent loop syndrome, this technique has been associated with higher clinical success and fewer reinterventions and adverse events when compared to enteral stenting and percutaneous drainage, respectively. Several randomized studies are currently underway evaluating EUS-GE in malignant gastric outlet obstruction (GOO), whereas more prospective data are still required on EDGE and long-term fistula management. Conclusion:EUS-GIA has become a crucial alternative to established techniques, overcoming technical limitations and subsequently improving patient outcomes. Although we should focus on prospective confirmation of these results in the context of GOO and EDGE, the current evidence already allows for a prominent role for EUS-GIA in our everyday practice.

show abstract

Management of choledocholithiasis after Roux-en-Y gastric bypass: a systematic review and pooled proportion meta-analysis

Cited by 18 publications

References 54 publications

Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022

Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2022

Abdominal Pain After Roux-en-Y Gastric Bypass

Endoscopic ultrasound‐guided gastrointestinal anastomosis: Current status and future perspectives

Contact Info

Product

Resources

About