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Endoscopy 2020; 52(08): 654-661
DOI: 10.1055/a-1139-9313
Original article

Laparoscopy-assisted versus balloon enteroscopy-assisted ERCP after Roux-en-Y gastric bypass

Christer Julseth Tønnesen
1   Clinical Effectiveness Research Group, Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
2   Section of Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
,
Juliet Young
1   Clinical Effectiveness Research Group, Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
,
Tom Glomsaker
3   Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Oslo, Norway
,
Tom Mala
3   Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Oslo, Norway
,
Magnus Løberg
1   Clinical Effectiveness Research Group, Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
2   Section of Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
,
Michael Bretthauer
1   Clinical Effectiveness Research Group, Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
2   Section of Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
,
Erle Refsum
1   Clinical Effectiveness Research Group, Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
,
Lars Aabakken
1   Clinical Effectiveness Research Group, Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
2   Section of Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
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Referred to by:

ERCP in patients with Roux-en-Y gastric bypass: is there a one-procedure-fits-all approach?Endoscopy 2020; 52(08): 662-663
DOI: 10.1055/a-1157-8933

See also:

Are balloon enteroscopy-assisted ERCP and laparoscopy-assisted ERCP in Roux-en-Y gastric bypass equivalent?Endoscopy 2021; 53(05): 558-558
DOI: 10.1055/a-1308-1970

Abstract

Background Patients who have undergone Roux-en-Y gastric bypass (RYGB) are at increased risk of biliary disease necessitating endoscopic retrograde cholangiopancreatography (ERCP). The most widely used approaches to perform ERCP after RYGB are laparoscopy-assisted ERCP (LA-ERCP) and balloon enteroscopy-assisted ERCP (BEA-ERCP). There are few studies comparing these procedures. We aimed to compare the performance, benefits, and harms of LA-ERCP and BEA-ERCP in RYGB patients.

Methods We identified all RYGB patients who underwent ERCP at two tertiary care endoscopy centers in Oslo, Norway between May 2013 and December 2017. One center performed BEA-ERCP, the other LA-ERCP. Procedure success was defined as fulfillment of the therapeutic or diagnostic aim, according to the procedure description. Adverse events were classified according to the Clavien–Dindo grading system.

Results During the study period, 40 BEA-ERCP and 39 LA-ERCP procedures were performed in 68 patients. Procedure success rate was 72.5 % for BEA-ERCP and 87.2 % for LA-ERCP (P = 0.14). Adverse events occurred in 18 % of BEA-ERCP and 28 % of LA-ERCP (P = 0.23). Serious adverse events (Clavien–Dindo grade ≥ 3b) occurred in 2.5 % of BEA-ERCP and 7.7 % of LA-ERCP procedures (P = 0.36). Concomitant cholecystectomy was performed in 25 of the 39 LA-ERCP procedures. The median procedure times for LA-ERCP performed with and without concomitant cholecystectomy were 201 minutes and 140 minutes, respectively, and for BEA-ERCP was 125 minutes.

Conclusions In experienced hands, both LA-ERCP and BEA-ERCP have high success rates after RYGB. The choice of approach should be individualized according to patient characteristics and available physician competence.



Publication History

Received: 07 October 2019

Accepted: 17 February 2020

Article published online:
21 April 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

  • References

  • 1 World Health Organization. Obesity and overweight Fact sheet. 2017
    PubMedSearch in Google Scholar
  • 2 Sjostrom L, Lindroos AK, Peltonen M. et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. NEJM 2004; 351: 2683-2693
    CrossrefPubMedSearch in Google Scholar
  • 3 Mingrone G, Panunzi S, De Gaetano A. et al. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet 2015; 386: 964-973
    CrossrefPubMedSearch in Google Scholar
  • 4 Brockmeyer JR, Grover BT, Kallies KJ. et al. Management of biliary symptoms after bariatric surgery. Am J Surg 2015; 210: 1010-1016 ; discussion 1016–1017
    CrossrefPubMedSearch in Google Scholar
  • 5 Jonas E, Marsk R, Rasmussen F. Incidence of postoperative gallstone disease after antiobesity surgery: population-based study from Sweden. Surg Obes Relat Dis 2010; 6: 54-58
    CrossrefPubMedSearch in Google Scholar
  • 6 Plecka Ostlund M, Wenger U, Mattsson F. et al. Population-based study of the need for cholecystectomy after obesity surgery. Br J Surg 2012; 99: 864-869
    CrossrefPubMedSearch in Google Scholar
  • 7 Aabakken L, Bretthauer M, Line PD. Double-balloon enteroscopy for endoscopic retrograde cholangiography in patients with a Roux-en-Y anastomosis. Endoscopy 2007; 39: 1068-1071
    Thieme ConnectPubMedSearch in Google Scholar
  • 8 Ali MF, Modayil R, Gurram KC. et al. Spiral enteroscopy-assisted ERCP in bariatric-length Roux-en-Y anatomy: a large single-center series and review of the literature (with video). Gastrointest Endosc 2018; 87: 1241-1247
    CrossrefPubMedSearch in Google Scholar
  • 9 Banerjee N, Parepally M, Byrne TK. et al. Systematic review of transgastric ERCP in Roux-en-Y gastric bypass patients. Surg Obes Relat Dis 2017; 13: 1236-1242
    CrossrefPubMedSearch in Google Scholar
  • 10 Saleem A, Baron TH, Gostout CJ. et al. Endoscopic retrograde cholangiopancreatography using a single-balloon enteroscope in patients with altered Roux-en-Y anatomy. Endoscopy 2010; 42: 656-660
    Thieme ConnectPubMedSearch in Google Scholar
  • 11 Shah RJ, Smolkin M, Yen R. et al. A multicenter, U.S. experience of single-balloon, double-balloon, and rotational overtube-assisted enteroscopy ERCP in patients with surgically altered pancreaticobiliary anatomy (with video). Gastrointest Endosc 2013; 77: 593-600
    CrossrefPubMedSearch in Google Scholar
  • 12 Abbas AM, Strong AT, Diehl DL. et al. Multicenter evaluation of the clinical utility of laparoscopy-assisted ERCP in patients with Roux-en-Y gastric bypass. Gastrointest Endosc 2018; 87: 1031-1039
    CrossrefPubMedSearch in Google Scholar
  • 13 Skinner M, Popa D, Neumann H. et al. ERCP with the overtube-assisted enteroscopy technique: a systematic review. Endoscopy 2014; 46: 560-572
    Thieme ConnectPubMedSearch in Google Scholar
  • 14 Inamdar S, Slattery E, Sejpal DV. et al. Systematic review and meta-analysis of single-balloon enteroscopy-assisted ERCP in patients with surgically altered GI anatomy. Gastrointest Endosc 2015; 82: 9-19
    CrossrefPubMedSearch in Google Scholar
  • 15 Choi EK, Chiorean MV, Coté GA. et al. ERCP via gastrostomy vs. double balloon enteroscopy surgery in patients with prior bariatric Roux-en-Y gastric bypass. Surg Endosc 2013; 27: 2894-2899
    CrossrefPubMedSearch in Google Scholar
  • 16 Trindade AJ, Mella JM, Slattery E. et al. Use of a cap in single-balloon enteroscopy-assisted endoscopic retrograde cholangiography. Endoscopy 2015; 47: 453-456
    Thieme ConnectPubMedSearch in Google Scholar
  • 17 Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240: 205-213
    CrossrefPubMedSearch in Google Scholar
  • 18 Clavien PA, Barkun J, de Oliveira ML. et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009; 250: 187-196
    Search in Google Scholar
  • 19 Cotton PB, Lehman G, Vennes J. et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 1991; 37: 383-393
    CrossrefPubMedSearch in Google Scholar
  • 20 Schreiner MA, Chang L, Gluck M. et al. Laparoscopy-assisted versus balloon enteroscopy-assisted ERCP in bariatric post-Roux-en-Y gastric bypass patients. Gastrointest Endosc 2012; 75: 748-756
    CrossrefPubMedSearch in Google Scholar
  • 21 Dalmonte G, Valente M, Bosi S. et al. Transjejunal laparoscopic-assisted ERCP: a technique to deal with choledocholithiasis after Roux-en-Y reconstruction. Obes Surg 2019;
    CrossrefPubMedSearch in Google Scholar
  • 22 Reinders JS, Gouma DJ, Ubbink DT. et al. Transcystic or transductal stone extraction during single-stage treatment of choledochocystolithiasis: a systematic review. World J Surg 2014; 38: 2403-2411
    CrossrefPubMedSearch in Google Scholar
  • 23 Somasekar K, Chan DSY, Sreekumar NS. et al. Choledocholithiasis after bariatric surgery-more than a stone's throw to reach?. J Gastrointest Surg 2018; 22: 529-537
    CrossrefPubMedSearch in Google Scholar
  • 24 Wang TJ, Thompson CC, Ryou M. Gastric access temporary for endoscopy (GATE): a proposed algorithm for EUS-directed transgastric ERCP in gastric bypass patients. Surg Endosc 2019;
    CrossrefPubMedSearch in Google Scholar
  • 25 Kedia P, Tarnasky PR, Nieto J. et al. EUS-directed transgastric ERCP (EDGE) versus laparoscopy-assisted ERCP (LA-ERCP) for Roux-en-Y gastric bypass (RYGB) anatomy: a multicenter early comparative experience of clinical outcomes. J Clin Gastroenterol 2019; 53: 304-308
    CrossrefPubMedSearch in Google Scholar
  • 26 Bukhari M, Kowalski T, Nieto J. et al. An international, multicenter, comparative trial of EUS-guided gastrogastrostomy-assisted ERCP versus enteroscopy-assisted ERCP in patients with Roux-en-Y gastric bypass anatomy. Gastrointest Endosc 2018; 88: 486-494
    CrossrefPubMedSearch in Google Scholar
  • 27 Welbourn R, Hollyman M, Kinsman R. et al. Bariatric surgery worldwide: baseline demographic description and one-year outcomes from the Fourth IFSO Global Registry Report 2018. Obes Surg 2019; 29: 782-795
    CrossrefPubMedSearch in Google Scholar