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DOI: 10.1055/s-0039-1681525
LAPAROSCOPY-ASSISTED VS. BALLOON ENTEROSCOPY-ASSISTED ERCP FOR POST BARIATRIC ROUX-EN-Y GASTRIC BYPASS PATIENTS
Publication History
Publication Date:
18 March 2019 (online)
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.