Ali M Abbas1, Andrew T Strong2, David L Diehl3, Brian C Brauer4, Iris H Lee5, Rebecca Burbridge6, Jaroslav Zivny7, Jennifer T Higa8, Marcelo Falcão9, Ihab I El Hajj10, Paul Tarnasky11, Brintha K Enestvedt12, Alexander R Ende13, Adarsh M Thaker14, Rishi Pawa15, Priya Jamidar16, Kartik Sampath17, Eduardo Guimarães Hourneaux de Moura18, Richard S Kwon19, Alejandro L Suarez20, Murad Aburajab21, Andrew Y Wang22, Mohammad H Shakhatreh23, Vivek Kaul24, Lorna Kang25, Thomas E Kowalski26, Rahul Pannala27, Jeffrey Tokar28, A Aziz Aadam29, Demetrios Tzimas30, Mihir S Wagh31, Peter V Draganov31. 1. University of South Florida Morsani College of Medicine, Tampa, Florida, USA. 2. Cleveland Clinic, Cleveland, Ohio, USA. 3. Geisinger Medical Center, Danville, Pennsylvania, USA. 4. University of Colorado, Aurora, Colorado, USA. 5. University of Maryland School of Medicine, Baltimore, Maryland, USA. 6. Duke University, Durham, North Carolina, USA. 7. University of Massachusetts, Worcester, Massachusetts, USA. 8. Virginia Mason Medical Center, Seattle, Washington, USA. 9. Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil. 10. Indiana University School of Medicine, Indianapolis, Indiana, USA. 11. Methodist Dallas Medical Center, Dallas, Texas, USA. 12. Oregon Health & Science University, Portland, Oregon, USA. 13. University of Washington, Seattle, Washington, USA. 14. David Geffen School of Medicine at UCLA, Los Angeles, California, USA. 15. Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA. 16. Yale School of Medicine, New Haven, Connecticut, USA. 17. Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA. 18. University of São Paulo Medical School, São Paulo, Brazil. 19. University of Michigan, Ann Arbor, Michigan, USA. 20. Medical University of South Carolina, Charleston, South Carolina, USA. 21. Medical College of Wisconsin, Milwaukee, Wisconsin, USA. 22. University of Virginia, Charlottesville, Virginia, USA. 23. Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA. 24. University of Rochester Medical Center, Rochester, New York, USA. 25. Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. 26. Thomas Jefferson University, Philadelphia, Pennsylvania, USA. 27. Mayo Clinic Scottsdale, Scottsdale, Arizona, USA. 28. Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA. 29. Northwestern University, Chicago, Illinois, USA. 30. Stony Brook University School of Medicine, Stony Brook, New York, USA. 31. University of Florida, Gainesville, Florida, USA.
Abstract
BACKGROUND AND AIMS: The obesity epidemic has led to increased use of Roux-en-Y gastric bypass (RYGB). These patients have an increased incidence of pancreaticobiliary diseases, yet standard ERCP is not possible because of surgically altered gastroduodenal anatomy. Laparoscopy-assisted ERCP (LA-ERCP) has been proposed as an option, but supporting data are derived from single-center small case series. Therefore, we conducted a large multicenter study to evaluate the feasibility, safety, and outcomes of LA-ERCP. METHODS: This is a retrospective cohort study of adult patients with RYGB who underwent LA-ERCP in 34 centers. Data on demographics, indications, procedure success, and adverse events were collected. Procedure success was defined when all the following were achieved: reaching the papilla, cannulating the desired duct, and providing endoscopic therapy as clinically indicated. RESULTS: A total of 579 patients (median age, 51; 84% women) were included. Indication for LA-ERCP was biliary in 89%, pancreatic in 8%, and both in 3%. Procedure success was achieved in 98%. Median total procedure time was 152 minutes (interquartile range [IQR], 109-210), with a median ERCP time of 40 minutes (IQR, 28-56). Median hospital stay was 2 days (IQR, 1-3). Adverse events were 18% (laparoscopy related, 10%; ERCP related, 7%; both, 1%) with the clear majority (92%) classified as mild/moderate, whereas 8% were severe and 1 death occurred. CONCLUSIONS: Our large multicenter study indicates that LA-ERCP in patients with RYGB is feasible with a high procedure success rate comparable with that of standard ERCP in patients with normal anatomy. The ERCP-related adverse events rate is comparable with conventional ERCP, but the overall adverse event rate was higher because of the added laparoscopy-related events.
BACKGROUND AND AIMS: The obesity epidemic has led to increased use of Roux-en-Y gastric bypass (RYGB). These patients have an increased incidence of pancreaticobiliary diseases, yet standard ERCP is not possible because of surgically altered gastroduodenal anatomy. Laparoscopy-assisted ERCP (LA-ERCP) has been proposed as an option, but supporting data are derived from single-center small case series. Therefore, we conducted a large multicenter study to evaluate the feasibility, safety, and outcomes of LA-ERCP. METHODS: This is a retrospective cohort study of adult patients with RYGB who underwent LA-ERCP in 34 centers. Data on demographics, indications, procedure success, and adverse events were collected. Procedure success was defined when all the following were achieved: reaching the papilla, cannulating the desired duct, and providing endoscopic therapy as clinically indicated. RESULTS: A total of 579 patients (median age, 51; 84% women) were included. Indication for LA-ERCP was biliary in 89%, pancreatic in 8%, and both in 3%. Procedure success was achieved in 98%. Median total procedure time was 152 minutes (interquartile range [IQR], 109-210), with a median ERCP time of 40 minutes (IQR, 28-56). Median hospital stay was 2 days (IQR, 1-3). Adverse events were 18% (laparoscopy related, 10%; ERCP related, 7%; both, 1%) with the clear majority (92%) classified as mild/moderate, whereas 8% were severe and 1 death occurred. CONCLUSIONS: Our large multicenter study indicates that LA-ERCP in patients with RYGB is feasible with a high procedure success rate comparable with that of standard ERCP in patients with normal anatomy. The ERCP-related adverse events rate is comparable with conventional ERCP, but the overall adverse event rate was higher because of the added laparoscopy-related events.
Authors: Tarek Sawas; Andrew C Storm; Fateh Bazerbachi; Chad J Fleming; Eric J Vargas; Vinay Chandrasekhara; James C Andrews; Michael J Levy; John A Martin; Bret T Petersen; Mark D Topazian; Barham K Abu Dayyeh Journal: Surg Endosc Date: 2019-05-28 Impact factor: 4.584
Authors: Harry Martin; Tareq El Menabawey; Orla Webster; Constantinos Parisinos; Michael Chapman; Stephen P Pereira; Gavin Johnson; George Webster Journal: Frontline Gastroenterol Date: 2021-02-24
Authors: Ignacio Fuente; Axel Beskow; Fernando Wright; Pedro Uad; Martín de Santibañes; Martin Palavecino; Rodrigo Sanchez-Claria; Juan Pekolj; Oscar Mazza Journal: Surg Endosc Date: 2021-01-04 Impact factor: 4.584