Endoscopy 2018; 50(04): S24-S25
DOI: 10.1055/s-0038-1637099
ESGE Days 2018 oral presentations
20.04.2018 – ERCP 1: cannulation and adverse effects
Georg Thieme Verlag KG Stuttgart · New York

BALLOON-OVERTUBE ENTEROSCOPY ASSISTED (BAE) VERSUS LAPAROSCOPY-ASSISTED ERCP IN BARIATRIC POST- ROUX-EN-Y GASTRIC BYPASS PATIENTS: A COMPARATIVE STUDY

A Martínez-Alcalá García
1   Hopsital UniversitarioInfanta Leonor, Madrid, Spain
,
U Kumar
2   University of Alabama, Birmingham, United States
,
PT Kröner
3   Mayo Clinic, Jacksonville, United States
,
I Jovanovic
4   University of Belgrade, Belgrade, Serbia
,
AM Ahmed
2   University of Alabama, Birmingham, United States
,
G Schwingel
5   Cirugia do Aparelho Digestivo, Sao Bento do Sul, Brazil
,
H Neumann
6   University of Mainz, Mainz, Germany
,
K Mönkemüller
7   Frankenwald Klinik, Kronach, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

Also available at
 

Aims:

To compare on balloon enteroscopy-assisted ERCP (BEA-ERCP) versus laparoscopy-assisted ERCP (LA-ERCP) in post-Roux-en-Y gastric bypass (RYGB) patients.

Methods:

Retrospective, observational, comparative, non-randomized, study of consecutive patients at a single institution evaluating patients with Roux-en-Y gastric bypass undergoing BAE-ERCP or LA-ERCP.

Results:

A total of 31 patients underwent 35 procedures (29 female, 2 male, mean age 52.4 years, range 32 to 67) during a 3-year period; 19 patients underwent LA-ERCP and 12 patients underwent BAE-ERCP. There were no statistically significant differences in age (51.5 vs. 52.1 years), gende, indication for ERCP (choledocolithiasis in 73 vs. 67%, suspected sphincter of Oddi dysfunction, 26 vs. 27%).

LA-ERCP was superior to BAE-ERCP in papilla identification (100% vrs 67%, p < 0.01). The ERCP success rate was also higher in the LA-ERCP group as compared to the BAE-ERCP group (89% vs. 50%, p < 0,01). Deep cannulation of the common bile duct failed in one patient undergoing LA-ERCP, in another patient it was impossible to remove the large impacted stones within the CBD. In three patients undergoing BAE-ERCP it was impossible to perform therapeutic biliopancreatic interventions despite successfully entering the biliodigestive limb. The total ERCP time was similar (LA-ERCP 63 minutes, range 22 to 110 min. vs. BAE-ERCP with a mean of 65 min, range 45 to 125 min). The hospital duration was 2.3 days in the LA-ERCP group and 1.2 day in the BAE-ERCP group (p = 0,02). Complication rate: 0% in BAE-ERCP and 17% in LA-ERCP group (two post-ERCP pancreatitis and one severe post-sphincterotomy bleeding) (P < 0,05).

Conclusions:

LA-ERCP offers a higher chance of therapeutic success in patients with Roux-en-Y gastric bypass. Nevertheless, as BAE-ERCP also leads to therapeutic success in about 50% of cases, and thus, starting with BAE-ERCP may offer a stepwise approach and avoid more invasiveness, longer hospitalization, and be more cost-effective.