BACKGROUND: Bariatric gastric bypass surgery is being increasingly performed, but endoscopic retrograde cholangiopancreatography (ERCP) in these patients poses a unique challenge because of a lack of per-oral access to the stomach. Small series suggest a higher technical success rate using laparoscopy-assisted ERCP (LA-ERCP) than with an enteroscopic approach via the Roux-en-Y anastomosis. We present initial experience of LA-ERCP in our unit. DESIGN: Retrospective case series of consecutive patients undergoing LA-ERCP in our unit between September 2011 and July 2014. Data was retrieved from electronic, clinical and endoscopy records. RESULTS: Seven LA-ERCPs were performed. All seven patients were female, with median age 44 years (range 36-71). Indications included symptomatic bile duct stones (5/7), benign papillary fibrosis (1/7) and retained biliary stent (1/7). 5/7 (71%) patients had had a prior cholecystectomy. To facilitate LA-ERCP, laparoscopic gastrostomy ports were created in all patients. Duodenal access, biliary cannulation and completion of therapeutic aim were achieved in all patients. 6/7 (86%) patients required endoscopic sphincterotomy. The median duration of procedures was 94 min (range 70-135). Median postoperative length of stay was 2 days (range 1-9). One patient developed mild postprocedural acute pancreatitis, and another patient developed a mild port-site infection. Otherwise, no procedure-related complications were seen. All patients remained well on follow-up (median 14 months (range 1-35) from date of ERCP), with no evidence of further biliary symptoms. CONCLUSIONS: Our early experience of LA-ERCP is that it is safe and effective. The technique may require particular consideration, as bariatric surgery is increasingly performed, in a patient group at significant risk of bile duct stones.
BACKGROUND: Bariatric gastric bypass surgery is being increasingly performed, but endoscopic retrograde cholangiopancreatography (ERCP) in these patients poses a unique challenge because of a lack of per-oral access to the stomach. Small series suggest a higher technical success rate using laparoscopy-assisted ERCP (LA-ERCP) than with an enteroscopic approach via the Roux-en-Y anastomosis. We present initial experience of LA-ERCP in our unit. DESIGN: Retrospective case series of consecutive patients undergoing LA-ERCP in our unit between September 2011 and July 2014. Data was retrieved from electronic, clinical and endoscopy records. RESULTS: Seven LA-ERCPs were performed. All seven patients were female, with median age 44 years (range 36-71). Indications included symptomatic bile duct stones (5/7), benign papillary fibrosis (1/7) and retained biliary stent (1/7). 5/7 (71%) patients had had a prior cholecystectomy. To facilitate LA-ERCP, laparoscopic gastrostomy ports were created in all patients. Duodenal access, biliary cannulation and completion of therapeutic aim were achieved in all patients. 6/7 (86%) patients required endoscopic sphincterotomy. The median duration of procedures was 94 min (range 70-135). Median postoperative length of stay was 2 days (range 1-9). One patient developed mild postprocedural acute pancreatitis, and another patient developed a mild port-site infection. Otherwise, no procedure-related complications were seen. All patients remained well on follow-up (median 14 months (range 1-35) from date of ERCP), with no evidence of further biliary symptoms. CONCLUSIONS: Our early experience of LA-ERCP is that it is safe and effective. The technique may require particular consideration, as bariatric surgery is increasingly performed, in a patient group at significant risk of bile duct stones.
Authors: Mitchal A Schreiner; Lily Chang; Michael Gluck; Shayan Irani; S Ian Gan; John J Brandabur; Richard Thirlby; Ravi Moonka; Richard A Kozarek; Andrew S Ross Journal: Gastrointest Endosc Date: 2012-01-31 Impact factor: 9.427
Authors: Raj J Shah; Maximiliano Smolkin; Roy Yen; Andrew Ross; Richard A Kozarek; Douglas A Howell; Gennadiy Bakis; Sreenivasan S Jonnalagadda; Abed A Al-Lehibi; Al Hardy; Douglas R Morgan; Amrita Sethi; Peter D Stevens; Paul A Akerman; Shyam J Thakkar; Brian C Brauer Journal: Gastrointest Endosc Date: 2013-01-03 Impact factor: 9.427
Authors: Matthew Connell; Warren Y L Sun; Valentin Mocanu; Jerry T Dang; Janice Y Kung; Noah J Switzer; Daniel W Birch; Shahzeer Karmali Journal: Surg Endosc Date: 2022-01-18 Impact factor: 3.453
Authors: Banreet Singh Dhindsa; Amaninder Dhaliwal; Babu P Mohan; Harmeet Singh Mashiana; Mohit Girotra; Shailender Singh; Gordon Ohning; Ishfaq Bhat; Douglas G Adler Journal: Endosc Int Open Date: 2020-01-22