ERCP in patients with long-limb Roux-en-Y gastrojejunostomy and intact papilla

Wright, Brian D.; Cass, Oliver W.; Freeman, Martin L.

doi:10.1016/s0016-5107(02)70182-x

Cited by 267 publications

(176 citation statements)

References 18 publications

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“…Endoscopic biliary drainage in patients with acute cholangitis showed that is safe and effective procedure and associated with a lower mortality rate and lower hospital stay when compare it to the group of patients who underwent surgical decompression approach [11,12].…”

Section: Discussionmentioning

confidence: 96%

G-Tube Guided Endoscopic Retrograde Cholangiopancreatography; A Lifesaving Procedure

Al-Azzawi¹,

Fasullo²,

Marshall³

et al. 2017

Pancreat Disord Ther

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Section: Discussionmentioning

confidence: 96%

G-Tube Guided Endoscopic Retrograde Cholangiopancreatography; A Lifesaving Procedure

Al-Azzawi¹,

Fasullo²,

Marshall³

et al. 2017

Pancreat Disord Ther

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“…Complications of RYGB are varied and are dependent on surgical approach (open versus laparoscopic). They include gastric remnant distension, stomal stenosis, marginal ulcers, cholelithiasis, hernias and Dumping/Short Bowel Syndrome amongst others [38].Given the sheer volume of RYGB procedures being performed and the associated predicted increase in complications, advanced endoscopists can expect to encounter more patients with surgically altered anatomy in the years to come and hence the need for more training.…”

Section: Discussion/conclusionmentioning

confidence: 99%

The Role of Overtube-assisted Deep Enteroscopy ERCP in Roux-en-Y Gastric Bypass Patients

Ali¹,

Ahmed²,

Iqbal³

2014

J Obes Weight Loss Ther

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Bariatric surgery is the fastest growing medical intervention for obesity performed in theUS and Roux-en-Y Gastric Bypass (RYGB), is considered the "gold standard"comprising more than 60% of these cases. However, patients with surgically alteredanatomy after undergoing RYGB pose serious challenges to the endoscopist whenaccess to the biliary or pancreatic systems is required. Hurdles include reaching themajor papilla after navigating the length of the roux limb (often >100 cm) given thelimitations of standard gastroscopes and even push enteroscopes in achievingsufficient depth of insertion, orientation (upside-down configuration of the papilla), andthe lack of accessories that are actually designed for the long endoscopes required forperforming ERCPs in this patient population.To work around the aforementioned problems-specifically the length of the Rouxlimb-innovative techniques, notably overtube systems have been developed to allowthe enteroscope to reach the ampulla and perform ERCP. Three overtube-systems arepresently available: Double-balloon Enteroscopy (DBE), Single-balloon Enteroscopy(SBE), and Spiral Enteroscopy (SE). This review is designed to describe the role of these 3overtube systems in assisting with ERCP in RYGB patients based on existing literatureand evaluate their success rates in reaching the ampulla, diagnostic & therapeuticyields, and complication rates.Our review shows good success rates when comparing ability to reach ampulla (DBEERCP:83%; SBE-ERCP: 71%; SE-ERCP: 70%), diagnostic (DBE-ERCP: 77%; SBEERCP:55%; SE-ERCP: 41%) and therapeutic yields (DBE-ERCP: 75%; SBE-ERCP:81%; SE-ERCP: 68%) with low complication rates for all three systems.The sheer volume of RYGB procedures being performed and the associated predictedincrease in complications will lead to advanced endoscopists encountering morepatients with surgically altered anatomy and our review provides evidence thatovertube-assisted systems are effective and safe, and should be considered as a firstline modality in RYGB patients requiring ERCP.

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“…Wright et al described 15 patients with roux-en Y anatomy in whom ERCP was attempted. 6 In each case, with use of a forward viewing enteroscope or colonoscope, attempts were made to reach the papilla and perform ERCP. Despite reaching the papilla in 12 patients, ERCP was only successful in 2 patients using a colonoscope.…”

Section: Enteroscopes or Colonoscopes Through The Anatomic Routementioning

confidence: 99%

Endoscopic retrograde cholangiopancreatography in patients with roux-en-Y anatomy

Samarasena

Nguyen²,

Lee³

2012

jig

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ERCP in patients with long-limb Roux-en-Y gastrojejunostomy and intact papilla

Cited by 267 publications

References 18 publications

G-Tube Guided Endoscopic Retrograde Cholangiopancreatography; A Lifesaving Procedure

G-Tube Guided Endoscopic Retrograde Cholangiopancreatography; A Lifesaving Procedure

The Role of Overtube-assisted Deep Enteroscopy ERCP in Roux-en-Y Gastric Bypass Patients

Endoscopic retrograde cholangiopancreatography in patients with roux-en-Y anatomy

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