Neal Mehta1, Andrew T Strong2, Tyler Stevens3, Kevin El-Hayek2, Alfred Nelson1, Adeyinka Owoyele4, Ahmed Eltelbany1, Prabhleen Chahal3, Maged Rizk3, Carol A Burke3, John McMichael2, Rocio Lopez5, Joseph Veniero4, John Vargo3, Matthew Kroh2, Amit Bhatt6,7. 1. Department of Internal Medicine, Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. 2. Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. 3. Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. 4. Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. 5. Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. 6. Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. bhatta3@ccf.org. 7. Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Desk A30, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. bhatta3@ccf.org.
Abstract
BACKGROUND: Biliary dilation suggests obstruction and prompts further work up. Our experience with endoscopic ultrasound and endoscopic retrograde cholangiopancreatography in the symptomatic post-bariatric surgery population revealed many patients with radiographically dilated bile ducts, but endoscopically normal studies. It is unclear if this finding is phenomenological or an effect of surgery. Additionally, it is unknown whether the type of bariatric surgery alters biliary pathophysiology. Thus, we studied whether a change occurs in biliary diameter following Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). METHODS: A single-center retrospective study assessing biliary diameter before and after RYGB or SG based on radiographic imaging. All adult patients undergoing RYGB or SG from January 2010 to December 2013 who had imaging studies before and > 3 months after surgery were included. Those with known obstructive etiologies and those without post-operative imaging were excluded. Common bile duct (CBD) diameter was re-read by a radiologist at the same location in the CBD for pre- and post-operative imaging. Baseline clinical factors and cholecystectomy status were collected. RESULTS: 269 patients met inclusion criteria (193 RYGB;76 SG). Between the groups, there were no significant differences in pre-operative characteristics. Average time from surgery to repeat imaging was 24.1 months. After adjusting for pre-operative factors, subjects who underwent an RYGB had an increase in CBD diameter of 1.4 mm (95% CI 0.096, 0.18), which was greater than the change following SG 0.5 mm(95% CI - 0.007, 0.11). The magnitude of this change did not depend on prior cholecystectomy in the RYGB cohort. Within the SG group, for patients without a prior cholecystectomy, there was a significant increase in post-operative CBD diameter of 0.8 mm(95% CI 0.02, 0.14). CONCLUSION: Bariatric surgery results in CBD dilation, with changes more pronounced after RYGB. Biliary dilation occurs irrespective of cholecystectomy status. Further work is necessary to determine the cause and clinical implications of this phenomenon.
BACKGROUND: Biliary dilation suggests obstruction and prompts further work up. Our experience with endoscopic ultrasound and endoscopic retrograde cholangiopancreatography in the symptomatic post-bariatric surgery population revealed many patients with radiographically dilated bile ducts, but endoscopically normal studies. It is unclear if this finding is phenomenological or an effect of surgery. Additionally, it is unknown whether the type of bariatric surgery alters biliary pathophysiology. Thus, we studied whether a change occurs in biliary diameter following Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). METHODS: A single-center retrospective study assessing biliary diameter before and after RYGB or SG based on radiographic imaging. All adult patients undergoing RYGB or SG from January 2010 to December 2013 who had imaging studies before and > 3 months after surgery were included. Those with known obstructive etiologies and those without post-operative imaging were excluded. Common bile duct (CBD) diameter was re-read by a radiologist at the same location in the CBD for pre- and post-operative imaging. Baseline clinical factors and cholecystectomy status were collected. RESULTS: 269 patients met inclusion criteria (193 RYGB;76 SG). Between the groups, there were no significant differences in pre-operative characteristics. Average time from surgery to repeat imaging was 24.1 months. After adjusting for pre-operative factors, subjects who underwent an RYGB had an increase in CBD diameter of 1.4 mm (95% CI 0.096, 0.18), which was greater than the change following SG 0.5 mm(95% CI - 0.007, 0.11). The magnitude of this change did not depend on prior cholecystectomy in the RYGB cohort. Within the SG group, for patients without a prior cholecystectomy, there was a significant increase in post-operative CBD diameter of 0.8 mm(95% CI 0.02, 0.14). CONCLUSION: Bariatric surgery results in CBD dilation, with changes more pronounced after RYGB. Biliary dilation occurs irrespective of cholecystectomy status. Further work is necessary to determine the cause and clinical implications of this phenomenon.
Entities:
Keywords:
Bariatric surgery; Common bile duct dilation; Interventional endoscopy; Roux-en-Y gastric bypass; Sleeve gastrectomy
Authors: John T Maple; Tamir Ben-Menachem; Michelle A Anderson; Vasundhara Appalaneni; Subhas Banerjee; Brooks D Cash; Laurel Fisher; M Edwyn Harrison; Robert D Fanelli; Norio Fukami; Steven O Ikenberry; Rajeev Jain; Khalid Khan; Mary Lee Krinsky; Laura Strohmeyer; Jason A Dominitz Journal: Gastrointest Endosc Date: 2010-01 Impact factor: 9.427
Authors: Tatum A McArthur; Virginia Planz; Naomi S Fineberg; Franklin N Tessler; Michelle L Robbin; Mark E Lockhart Journal: J Ultrasound Med Date: 2013-08 Impact factor: 2.153
Authors: C Niederau; J Müller; A Sonnenberg; T Scholten; J Erckenbrecht; W P Fritsch; T Brüster; G Strohmeyer Journal: J Clin Ultrasound Date: 1983-01 Impact factor: 0.910