EFFECTIVENESS AND SAFETY OF LAPAROSCOPY-ASSISTED TRANSGASTRIC ENDOSCOPIC RETROGRADE CHOLANGIOGRAPHY IN A LARGE POPULATION OF PATIENTS WITH ROUX-AND-Y GASTRIC BYPASS

Aims Conventional endoscopic retrograde cholangiopancreaticography (ERCP) is anatomically challenging in patients with a Roux-and-Y gastric bypass (RYGB). Laparoscopic-assisted transgastric endoscopic retrograde cholangiography (LAERC) is an alternatives as it allows access to the biliary tree via the gastric remnant. We investigated the effectiveness and safety of LAERC in patients with a RYGB.

Methods We retrospectively reviewed all charts from RYGB patients who underwent a LAERC between January 2009 and August 2019 in Rijnstate Hospital. Patients who underwent pancreatic therapy were excluded. We collected demographic, clinical and outcome data. An adverse effect was defined as any complaint related to the LAERC up to 30 days after the procedure and graded according to the ASGE lexicon.

Results We identified 100 LAERC in 86 patients with RYGB. Median age at LAERC was 54 years of whom 70% female. Simultaneous cholecystectomy was performed in 35 LAERC (35%). The therapeutic success rate was 95%. Stone extraction succeeded in 88.8% and sphincterotomy was performed in 96.7%. We identified 30 adverse effects regarding 28 procedures, whereof 8 endoscopy-related, 14 laparoscopy-related and 8 non-specified. In total, 6 severe adverse effects were seen concerning post-ERCP pancreatitis (n=2), laparoscopy-related hemorrhage (n=1), abscess (n=1), shock (n=1) and pneumonia (n=1). No patient died because of a LAERC-associated cause.

Conclusions LAERC is a safe and effective approach for biliary diseases in patients with RYGB if performed by an experienced gastroenterologist.