Endoscopic Management of Biliopancreatic Pathology in Patients With ROUX-EN-Y Gastric Bypass: What, When and How?

Aims We evaluated efficacy and safety of single-balloon enteroscopy-assisted ERCP (SBE-ERCP) as first line therapy in Roux-en-Y gastric bypass (RYGB) patients. In case of failure, second line endoscopic therapy based on EUS-transgastric ERCP (EDGE), percutaneous transhepatic cholangiography (PTC) or laparoscopy-assisted ERCP (LA-ERCP) was performed.

Methods A monocentric retrospective study of consecutive RYGB patients with biliopancreatic pathology were referred for SBE-ERCP or EDGE between June 2014 and November 2020. SBE-ERCP was considered first line technique because of its safety profile without transmural approach. Multistep EDGE was proposed when multiple and/or complex ERCP procedures were planned or when SBE-ERCP failed. LA-ERCP was proposed when SBE-ERCP failed in a patient who also needed cholecystectomy.

Results 61 RYGB patients (43 women; mean age 54±8 years) were included. Indications were biliary disease in 51, pancreatic disease in 7 and both in 3 patients. 57 patients underwent first line SBE-ERCP with a total of 71 SBE-ERCP procedures and 4 underwent first line EDGE. Average procedure time of SBE-ERCP was 87±22 min. Technical SBE-ERCP success rate was 56/71 (78.9 %) procedures. Clinical SBE-ERCP success rate was 42/57 (73.7 %) patients. Mild adverse events were self-limiting cholangitis, pancreatitis or abdominal pain in 8/71 (11.3 %) procedures. There were no serious adverse events. Alternative endoscopic therapy (5 EDGE, 1 LA-ERCP, 2 combined PTC with redo SBE-ERCP) allowed additional successful treatment of 8/15 (53.3 %) patients after failed SBE-ERCP, and together with 3/4 (75.0 %) first-line EDGE procedures, leading to an overall clinical success rate using endoscopic techniques of 53/61 (86.9 %) patients.

Conclusions Thanks to its good technical and clinical efficacy and excellent safety profile, SBE-ERCP seems to be a good first line option to treat biliopancreatic pathology in RYGB patients. Alternative second line options are EDGE, PTC and LA-ERCP depending on the indication.

Citation Monino L, Garces-Duran R, Piessevaux H et al. eP373 ENDOSCOPIC MANAGEMENT OF BILIOPANCREATIC PATHOLOGY IN PATIENTS WITH ROUX-EN-Y GASTRIC BYPASS: WHAT, WHEN AND HOW? Endoscopy 2021; 53: S218.

Publication History

Article published online:
19 March 2021