CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(10): E1276-E1280
DOI: 10.1055/a-0832-1898
Original article
Owner and Copyright © Georg Thieme Verlag KG 2019

Overall outcomes of laparoscopic-assisted ERCP after Roux-en-Y gastric bypass and sphincter of Oddi dysfunction subgroup analysis

David May
1  Lovelace Health System, Albuquerque, New Mexico, United States
,
Ellen Vogels
2  Sanford Medical Center, Fargo, North Dakota, United States
,
David Parker
3  Geisinger Medical Center, Danville, Pennsylvania, United States
,
Anthony Petrick
3  Geisinger Medical Center, Danville, Pennsylvania, United States
,
David Diehl
3  Geisinger Medical Center, Danville, Pennsylvania, United States
,
Jon Gabrielsen
3  Geisinger Medical Center, Danville, Pennsylvania, United States
› Author Affiliations
Further Information

Publication History

submitted 08 August 2018

accepted after revision 04 December 2018

Publication Date:
01 October 2019 (online)

  

Abstract

Background and study aims Biliary access following Roux-en-Y gastric bypass (RYGB) anatomy presents a significant challenge. Long-term outcomes of laparoscopic-assisted trans-gastric ERCP (LA-ERCP) including sphincter of Oddi dysfunction (SOD) subtypes have not been thoroughly examined. Our study aims to present our overall outcomes of trans-gastric LAERCP and examine a significant subgroup of patients with SOD after RYGB.

Patients and methods A retrospective review of RYGB patients who underwent LA-ERCP between 2009 and 2016 identified 51 patients. A subgroup of 22 patients with SOD were examined and contacted by phone survey to determine long-term symptom resolution.

Results Post-procedure length of stay was 1.9 days (SD 3.0). There was one conversion from laparoscopic to open procedure. Selective cannulation rate was 100 %. Mean follow-up was 14.6 months. There were two major operative complications, two major ERCP-related complications, and five wound infections (9.8 %). No deaths or episodes of pancreatitis occurred. Seventeen patients had biliary SOD (Type I = 9, Type II = 8). The remaining four had pancreatic SOD (Type I = 1, Type II = 4). SOD subgroup follow-up was 21.4 months (SD 18.1). All patients with Type I biliary and 75 % with Type I pancreatic SOD reported complete resolution of their symptoms.

Conclusions Consistent with other published series, LA-ERCP yields excellent cannulation rates after RYGB. Successful treatment of pancreatic and Type 1 biliary SOD suggests that there is significant symptomatic benefit to treating this patient population. However, an overall complication rate of approximately 15 % with LAERCP leaves open the possibility for improvements in access techniques in post-RYGB patients.