Endoscopic treatment of sphincter of Oddi dysfunction in patients with Roux-en-Y gastric bypass: technical and clinical outcomes

Aims Sphincter of Oddi dysfunction (SOD) is characterized by typical colic pain of biliary and/or pancreatic origin, in association with disturbed liver and/or pancreatic function tests and with radiological stigmata of poor transpapillar drainage (SOD type I). In SOD type II typical pain is associated with either biochemical or radiological abnormalities and in SOD type III only typical colic pain is present. We studied technical and clinical outcomes of endoscopic SOD treatment (biliary and/or pancreatic sphincterotomy) in Roux-en-Y gastric bypass (RYGB) patients.

Methods Retrospective analysis of a prospective cohort of RYGB patients who underwent ERCP between 2014 and 2024.

Results A total of 19 patients (17 female, aged 47±3 years) were referred for endoscopic SOD treatment. 84% (n=16) had undergone cholecystectomy. Mean time between RYGB surgery and endoscopic SOD treatment was 6±1 y. All patients underwent enteroscopy-assisted endoscopic retrograde cholangiopancreatography (entero-ERCP) using single-balloon enteroscopy, except for 1 case with the motorized spiral enteroscope. In case of technical failure endoscopic ultrasound-guided transgastric ERCP (EDGE) was performed. Technical success as defined by endoscopic sphincterotomy during one-stage entero-ERCP reached 79% (n=15) and increased to 90% (n=17) with 2 successful multi-stage EDGE procedures. For 2 entero-ERCP failures a wait-and-see approach was conducted. Clinical success as defined by pain relief and biochemical improvement during follow-up was significantly higher (86%) in 14 SOD I patients as compared to 5 SOD II and III patients (40%, p=0.046 Chi-square). There were 2 adverse events related to the ERCP procedure: 1 post-ERCP pancreatitis (AGREE II) and 1 fausse guidewire route during biliary cannulation (AGREE I). There were no serious adverse events.

Conclusions Entero-ERCP using single-balloon enteroscopy is a very effective and safe procedure to treat RYGB patients suffering from SOD type I. Clinical outcome of endoscopic sphincterotomy in SOD II and III RYGB patients remains questionable.

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Artikel online veröffentlicht:
27. März 2025