Laparoscopic-Assisted Endoscopic Retrograde Cholangiopancreatography (ERCP) Versus Endoscopic Ultrasound-Directed Transgastric ERCP in Patients With Roux-en-Y Gastric Bypass: A Systematic Review and Meta-Analysis

Oliveira, Victor De; Júnior, Epifânio S do Monte; Proença, Igor Mendonça; Ribeiro, Igor Braga; Sánchez-Luna, Sergio A.; Ribas, Pedro Henrique Boraschi Vieira; Hemerly, Matheus C; Bernardo, Wanderley Marques; Moura, Eduardo Guimarães Hourneaux de

doi:10.7759/cureus.30196

Cited by 7 publications

(5 citation statements)

References 31 publications

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“…The EDGE procedure is quickly replacing laparoscopic-assisted ERCP due to its entirely endoscopic approach, acceptable risk profile, and technical success rates in the 90% to 100% range . Moreover, in retrospective studies, the EDGE procedure has been found to have similar rates of stone clearance and adverse events as laparoscopic common bile duct exploration . During the EDGE procedure, endoscopic access to the remnant stomach is achieved by creating a gastro-gastric or jejunal-gastric fistula via a temporary lumen apposing metal stent (Figure 3).…”

Section: Discussion and Observationsmentioning

confidence: 99%

Abdominal Pain After Roux-en-Y Gastric Bypass

Fry,

Finks

2023

JAMA Surg

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ImportanceRoux-en-Y gastric bypass (RYGB) remains one of the most commonly performed operations for morbid obesity and is associated with significant long-term weight loss and comorbidity remission. However, health care utilization rates following RYGB are high and abdominal pain is reported as the most common presenting symptom for those seeking care.ObservationsGiven the limitations of physical examination in patients with obesity, correct diagnosis of abdominal pain following RYGB depends on a careful history and appropriate use of radiologic, laboratory and endoscopic studies, as well as a clear understanding of post-RYGB anatomy. The most common etiologies of abdominal pain after RYGB are internal hernia, marginal ulcer, biliary disease (eg, cholelithiasis and choledocholithiasis), and jejunojejunal anastomotic issues. Early identification of the etiology of the pain is essential, as some causes, such as internal hernia or perforated gastrojejunal ulcer, may require urgent or emergent intervention to avoid significant morbidity. While laboratory findings and imaging may prove useful, they remain imperfect, and clinical judgment should always be used to determine if surgical exploration is warranted.Conclusions and RelevanceThe etiologies of abdominal pain after RYGB range from the relatively benign to potentially life-threatening. This Review highlights the importance of understanding key anatomical and technical aspects of RYGB to guide appropriate workup, diagnosis, and treatment.

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Section: Discussion and Observationsmentioning

confidence: 99%

Abdominal Pain After Roux-en-Y Gastric Bypass

Fry,

Finks

2023

JAMA Surg

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“…Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS), the standard modalities for the diagnosis and management of PB pathologies, are challenging or unfeasible in patients with SAA [15]. Traditional endoscopic modalities for the management of these patients have included enteroscopy-assisted ERCP (e-ERCP) [16], EUS-guided biliary drainage [17], or the more invasive laparoscopic-assisted ERCP (LA-ERCP) [18]. The decision is often guided by the type of the SAA and the anatomic consideration, available expertise, and the scope of the anticipated therapeutic interventions [17].…”

Section: Pancreaticobiliary Interventionsmentioning

confidence: 99%

Use of lumen apposing metal stents in patients with altered gastrointestinal anatomy

Ichkhanian,

Jovani

2023

Current Opinion in Gastroenterology

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Purpose of review Lumen apposing metal stents (LAMS) have been increasingly used to manage patients with surgically altered anatomy (SAA), who would have otherwise required percutaneous or surgical interventions. Via the creation of de-novo anastomoses, LAMS provides a conduit to access distal parts of the gastrointestinal tract to perform various interventions. Recent findings Pancreatobiliary (PB) and non-PB interventions are challenging in patients with SAA. Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP) (EDGE) and endoscopic ultrasound (EUS)-directed transenteric ERCP (EDEE) are effective procedures that are being increasingly utilized to perform ERCP in patient with Roux-en-Y gastric bypass (RYGB) and non-RYGB SAA, respectively. Furthermore, EUS-directed trans-gastric intervention (EDGI) is a collective term for the non-PB procedures that could be performed in patients with SAA. EDGE/EDEE/EDGI are considered relatively safe procedures, however, intra-procedural stent misdeployement, and long-term ramifications of persistent fistula and stent migration could require endoscopic or, in rare instances, surgical management. Summary The advent of LAMS has revolutionized the therapeutic capabilities of EUS, by allowing the creation of new gastrointestinal anastomoses. With the growing body of literature, it is expected that such techniques will be more commonly performed in the community, providing less invasive and more effective treatment options for patients with SAA.

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“…Interventional radiologists can use a percutaneous rendezvous technique to access the biliary tree with or without concurrent ERCP. In centers without this expertise or after failure of these attempts, a laparoscopically assisted transgastric ERCP is an excellent option that can readily be performed by any surgeon with basic laparoscopic skills in concert with their interventional gastroenterologist 67,68 . The distal greater curve of the gastric remnant is mobilized, and an anterior 1 to 2 cm gastrotomy is created to facilitate passage of the endoscope into the remnant (Fig.…”

Section: Gastric Bypass Complicationsmentioning

confidence: 99%

Common postbariatric surgery emergencies for the acute care surgeon: What you need to know

Cheng,

Samakar,

Dobrowolsky

et al. 2023

J Trauma Acute Care Surg

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The field of bariatric and metabolic surgery has changed rapidly over the past two decades, with an exponential increase in case volumes being performed because of its proven efficacy for morbid obesity and obesity-related comorbidities. Although this increased volume of procedures has been accompanied by significant decrease in postoperative complication rates, there are numerous potential complications after bariatric surgery that may require urgent or emergent surgical evaluation or interventions. Many of these risks extend well beyond the early postoperative period and can present months to years after the index procedure. Acute care surgeons are increasingly covering most or all of the emergency general surgery services at many centers and must be familiar with the numerous bariatric surgical procedures being performed and their individual complication profile to provide optimal care for these frequently challenging patients. This article provides a focused and concise review of the common bariatric procedures being performed, their early and late complication profiles, and a practical guide to the optimal diagnostic evaluations, surgical interventions, and perioperative management options. The author group includes both acute care surgeons and bariatric surgeons with significant experience in the emergency management of the complicated postbariatric surgical patient. LEVEL OF EVIDENCE Literature Synthesis and Expert Opinion; Level V.

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Laparoscopic-Assisted Endoscopic Retrograde Cholangiopancreatography (ERCP) Versus Endoscopic Ultrasound-Directed Transgastric ERCP in Patients With Roux-en-Y Gastric Bypass: A Systematic Review and Meta-Analysis

Cited by 7 publications

References 31 publications

Abdominal Pain After Roux-en-Y Gastric Bypass

Abdominal Pain After Roux-en-Y Gastric Bypass

Use of lumen apposing metal stents in patients with altered gastrointestinal anatomy

Common postbariatric surgery emergencies for the acute care surgeon: What you need to know

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