Thomas J Wang1,2, Marvin Ryou1,3. 1. Harvard Medical School. 2. Massachusetts General Hospital. 3. Brigham and Women's Hospital, Boston, Massachusetts, USA.
Abstract
PURPOSE OF REVIEW: The present review describes the current and evolving techniques available in approaching endoscopic retrograde cholangiopancreatography (ERCP) for patients with Roux-en-Y gastric bypass (RYGB) anatomy. RECENT FINDINGS: Recent studies have demonstrated that device-assisted enteroscopy (DAE) approaches have high failures rates when performing ERCP, but are currently considered the first-line approach for patients with RYGB anatomy because of lower costs and risks compared to surgery. In contrast, laparoscopicy-assisted-ERCP (LA-ERCP) exhibits high technical success rates but carries surgical risks and requires a high degree of scheduling coordination. A novel, completely endoscopic approach called endoscopic ultrasound directed transgastric ERCP (EDGE), also known as gastric access temporary for endoscopy (GATE), has in recent years shown high ERCP success rates comparable to LA-ERCPs while obviating the need for surgical assistance. SUMMARY: ERCP is technically difficult in patients with RYGB anatomy. Numerous approaches to ERCP exist, although availability of these techniques may be limited and depend on institutional expertise. The best initial approach should be considered based on patient history and institutional factors.
PURPOSE OF REVIEW: The present review describes the current and evolving techniques available in approaching endoscopic retrograde cholangiopancreatography (ERCP) for patients with Roux-en-Y gastric bypass (RYGB) anatomy. RECENT FINDINGS: Recent studies have demonstrated that device-assisted enteroscopy (DAE) approaches have high failures rates when performing ERCP, but are currently considered the first-line approach for patients with RYGB anatomy because of lower costs and risks compared to surgery. In contrast, laparoscopicy-assisted-ERCP (LA-ERCP) exhibits high technical success rates but carries surgical risks and requires a high degree of scheduling coordination. A novel, completely endoscopic approach called endoscopic ultrasound directed transgastric ERCP (EDGE), also known as gastric access temporary for endoscopy (GATE), has in recent years shown high ERCP success rates comparable to LA-ERCPs while obviating the need for surgical assistance. SUMMARY: ERCP is technically difficult in patients with RYGB anatomy. Numerous approaches to ERCP exist, although availability of these techniques may be limited and depend on institutional expertise. The best initial approach should be considered based on patient history and institutional factors.
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
Authors: Mariano Giménez; Benôit Gallix; Guido Costamagna; Jean-Nicolas Vauthey; Michael Moche; Go Wakabayashi; Reto Bale; Lee Swanström; Jürgen Futterer; David Geller; Juan M Verde; Alain García Vazquez; Ivo Boškoski; Nicolas Golse; Beat Müller-Stich; Bernard Dallemagne; Mårten Falkenberg; Sven Jonas; Carina Riediger; Michele Diana; Niklas Kvarnström; Bruno C Odisio; Edgardo Serra; Christiaan Overduin; Mariano Palermo; Didier Mutter; Silvana Perretta; Patrick Pessaux; Luc Soler; Alexandre Hostettler; Toby Collins; Stéphane Cotin; Michael Kostrzewa; Amilcar Alzaga; Martin Smith; Jacques Marescaux Journal: Ann Surg Open Date: 2020-11-20
Authors: Firas Bahdi; Rollin George; Kavea Paneerselvam; Dang Nguyen; Wasif M Abidi; Mohamed O Othman; Isaac Raijman Journal: Endosc Int Open Date: 2022-04-14
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