Endoscopy 2019; 51(04): S120-S121
DOI: 10.1055/s-0039-1681525
ESGE Days 2019 oral presentations
Saturday, April 6, 2019 14:30 – 16:00: ERCP cannulation 2 South Hall 1A
Georg Thieme Verlag KG Stuttgart · New York

LAPAROSCOPY-ASSISTED VS. BALLOON ENTEROSCOPY-ASSISTED ERCP FOR POST BARIATRIC ROUX-EN-Y GASTRIC BYPASS PATIENTS

TC Julseth
1   Oslo University Hospital, Rikshospitalet, Department of Gastroenterology, Oslo, Norway
2   University of Oslo, Institute of Health and Society, Clinical Effectiveness Research Group, Oslo, Norway
,
T Glomsaker
3   Oslo University Hospital, Ullevål, Department of Gastroenterological Surgery, Oslo, Norway
,
T Mala
3   Oslo University Hospital, Ullevål, Department of Gastroenterological Surgery, Oslo, Norway
,
M Bretthauer
2   University of Oslo, Institute of Health and Society, Clinical Effectiveness Research Group, Oslo, Norway
,
J Young
4   University of Oslo, Faculty of Medicine, Oslo, Norway
,
E Refsum
2   University of Oslo, Institute of Health and Society, Clinical Effectiveness Research Group, Oslo, Norway
,
L Aabakken
1   Oslo University Hospital, Rikshospitalet, Department of Gastroenterology, Oslo, Norway
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Aims:

Roux-en-Y gastric bypass (RYGB) patients are at increased risk of biliary disease necessitating endoscopic retrograde cholangiopancreaticoscopy (ERCP), which poses a challenge due to the long endoscopic access route to the major papilla. The two most widely utilized treatment strategies are laparoscopy assisted ERCP (LA-ERCP) and balloon enteroscopy assisted ERCP (BEA-ERCP). There are few studies comparing these procedures. The aim of the current study was to compare the performance, benefits and harms of LA-ERCP and BEA-ERCP in a post RYGB patients.

Methods:

We compared electronic patient records of all ERCPs performed in RYGB patients at two tertiary care endoscopy centers in Oslo, Norway between 2008 and 2017. One center performed BEA-ERCP, while the other performed LA-ERCP for this patient group. The primary outcomes were procedure performance, success and adverse events.

Results:

During the 10-year study period, 61 BEA-ERCP and 39 LA-ERCP procedures were performed. Median procedure time was 125 minutes for BEA-ERCP, versus 182 minutes for LA-ERCP (p < 0.001). Procedure success rate was 67% for BEA-ERCP and 87% for LA-ERCP. The success rate for BEA-ERCP increased from 54% (first quintile) to 83% (last quintile) for BEA-ERCP, as compared to 88% to 100% for LA-ERCP. Concomitant cholecystectomy was performed during 64% (25/39) of LA-ERCP. Adverse events occurred in 26% (16/61) of BEA-ERCP and 28% (11/39) of LA-ERCP (p = 0.828). Serious adverse events, defined as Clavien-Dindo grade ≥3b, occurred in 1,6% (1/61) of BEA-ERCP and 7,7% (3/39) of LA-ERCP (p = 0.132).

Conclusions:

In experienced hands, laparoscopy-assisted and balloon enteroscopy-assisted ERCP for post bariatric Roux-en-Y gastric bypass patients have comparable success rates. Serious adverse events may be fewer with balloon-assisted ERCP, and it may be less time-consuming. However, concomitant cholecystectomy can be performed with LA-ERCP, but not with BEA-ERCP.