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Endoscopy 2020; 52(08): 654-661
DOI: 10.1055/a-1139-9313
Original article

Laparoscopy-assisted versus balloon enteroscopy-assisted ERCP after Roux-en-Y gastric bypass

Christer Julseth Tønnesen
1   Clinical Effectiveness Research Group, Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
2   Section of Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
,
Juliet Young
1   Clinical Effectiveness Research Group, Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
,
Tom Glomsaker
3   Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Oslo, Norway
,
Tom Mala
3   Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Oslo, Norway
,
Magnus Løberg
1   Clinical Effectiveness Research Group, Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
2   Section of Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
,
Michael Bretthauer
1   Clinical Effectiveness Research Group, Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
2   Section of Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
,
Erle Refsum
1   Clinical Effectiveness Research Group, Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
,
Lars Aabakken
1   Clinical Effectiveness Research Group, Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
2   Section of Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
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Referred to by:

ERCP in patients with Roux-en-Y gastric bypass: is there a one-procedure-fits-all approach?Endoscopy 2020; 52(08): 662-663
DOI: 10.1055/a-1157-8933

See also:

Are balloon enteroscopy-assisted ERCP and laparoscopy-assisted ERCP in Roux-en-Y gastric bypass equivalent?Endoscopy 2021; 53(05): 558-558
DOI: 10.1055/a-1308-1970

Abstract

Background Patients who have undergone Roux-en-Y gastric bypass (RYGB) are at increased risk of biliary disease necessitating endoscopic retrograde cholangiopancreatography (ERCP). The most widely used approaches to perform ERCP after RYGB are laparoscopy-assisted ERCP (LA-ERCP) and balloon enteroscopy-assisted ERCP (BEA-ERCP). There are few studies comparing these procedures. We aimed to compare the performance, benefits, and harms of LA-ERCP and BEA-ERCP in RYGB patients.

Methods We identified all RYGB patients who underwent ERCP at two tertiary care endoscopy centers in Oslo, Norway between May 2013 and December 2017. One center performed BEA-ERCP, the other LA-ERCP. Procedure success was defined as fulfillment of the therapeutic or diagnostic aim, according to the procedure description. Adverse events were classified according to the Clavien–Dindo grading system.

Results During the study period, 40 BEA-ERCP and 39 LA-ERCP procedures were performed in 68 patients. Procedure success rate was 72.5 % for BEA-ERCP and 87.2 % for LA-ERCP (P = 0.14). Adverse events occurred in 18 % of BEA-ERCP and 28 % of LA-ERCP (P = 0.23). Serious adverse events (Clavien–Dindo grade ≥ 3b) occurred in 2.5 % of BEA-ERCP and 7.7 % of LA-ERCP procedures (P = 0.36). Concomitant cholecystectomy was performed in 25 of the 39 LA-ERCP procedures. The median procedure times for LA-ERCP performed with and without concomitant cholecystectomy were 201 minutes and 140 minutes, respectively, and for BEA-ERCP was 125 minutes.

Conclusions In experienced hands, both LA-ERCP and BEA-ERCP have high success rates after RYGB. The choice of approach should be individualized according to patient characteristics and available physician competence.



Publication History

Received: 07 October 2019

Accepted: 17 February 2020

Article published online:
21 April 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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