Laparoscopic-Assisted Endoscopic Retrograde Cholangiopancreatography (ERCP) for Bile Duct Stones After Roux-en-Y-Gastric Bypass: Single-Centre Experience

Telfah, Muwaffaq Mezeil; Noble, Hamish; Mahon, David; Mason, Matthew; Hollyman, Marianne; Matull, R; Welbourn, Richard

doi:10.1007/s11695-020-04955-w

Cited by 9 publications

(6 citation statements)

References 15 publications

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“…The vast majority of patients ( n = 4934, 72.9%) underwent R-en-Y anastomosis and 38.9% ( n = 1919) of them represented bariatric cases with RYGB. Of note, studies investigating the role of EDGE [ 77 , 82 , 86 , 87 , 94 , 97 , 99 , 100 ] and LA-ERCP [ 48 , 74 , 76 , 78 , 79 , 80 , 83 , 84 , 85 , 88 , 89 , 90 , 91 , 94 , 95 , 99 , 100 ] exclusively enrolled RYGB cases, except for one per modality [ 75 , 81 ].…”

Section: Resultsmentioning

confidence: 99%

“…The quality assessment did not reveal major methodological pitfalls among the included studies. The most common shortcoming was the absence of detailed description of statistical models [ 34 , 37 , 38 , 40 , 44 , 47 , 48 , 49 , 50 , 56 , 58 , 59 , 60 , 62 , 66 , 69 , 71 , 77 , 80 , 84 , 85 , 86 , 88 , 90 , 91 , 93 , 104 ], though without impacting the overall quality. Moreover, some studies did not provide results about demographics, albeit information considering the estimation of our primary outcome was integral ( Supplementary Table S3 ) [ 17 , 36 , 77 , 84 , 93 , 94 , 99 , 100 ].…”

Section: Resultsmentioning

confidence: 99%

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Comparison between Enteroscopy-, Laparoscopy- and Endoscopic Ultrasound-Assisted Endoscopic Retrograde Cholangio-Pancreatography in Patients with Surgically Altered Anatomy: A Systematic Review and Meta-Analysis

Gkolfakis

Papaefthymiou

Facciorusso

et al. 2022

Life

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Background and Aims: Endoscopic retrograde cholangiopancreatography (ERCP), in surgically altered anatomy (SAA), can be challenging and the optimal technique selection remains debatable. Most common foregut interventions resulting to this burden consist of Billroth II gastrectomy, Whipple surgery and Roux-en-Y anastomoses, including gastric by-pass. This systematic review, with meta-analysis, aimed to compare the rates of successful enteroscope-assisted (EA)-, endosonography-directed transgastric- (EDGE), and laparoscopy-assisted (LA)-ERCP. Methods: A systematic research (Medline) was performed for relative studies, through January 2022. The primary outcome was technical success, defined as approaching the ampulla site. Secondary outcomes included the desired duct cannulation, successful therapeutic manipulations, and complication rates. We performed meta-analyses of pooled data, and subgroup analysis considering the EA-ERCP subtypes (spiral-, double and single balloon-enteroscope). Pooled rates are reported as percentages with 95% Confidence Intervals (95%CIs). Results: Seventy-six studies were included (3569 procedures). Regarding primary outcome, EA-ERCP was the least effective [87.3% (95%CI: 85.3–89.4); I2: 91.0%], whereas EDGE and LA-ERCP succeeded in 97.9% (95%CI: 96.4–99.4; I2: 0%) and 99.1% (95%CI: 98.6–99.7; I2: 0%), respectively. Similarly, duct cannulation and therapeutic success rates were 74.7% (95%CI: 71.3–78.0; I2: 86.9%) and 69.1% (95%CI: 65.3–72.9; I2: 91.8%) after EA-ERCP, 98% (95%CI: 96.5–99.6; I2: 0%) and 97.9% (95%CI: 96.3–99.4) after EDGE, and 98.6% (95%CI: 97.9–99.2; I2: 0%) and 98.5% (95%CI: 97.8–99.2; I2: 0%) after LA-ERCP, respectively. The noticed high heterogeneity in EA-ERCP results probably reflects the larger number of included studies, the different enteroscopy modalities and the variety of surgical interventions. Comparisons revealed the superiority of LA-ERCP and EDGE over EA-ERCP (p ≤ 0.001) for all success-related outcomes, though LA-ERCP and EDGE were comparable (p ≥ 0.43). ERCP with spiral-enteroscope was inferior to balloon-enteroscope, while the type of the balloon-enteroscope did not affect the results. Most adverse events were recorded after LA-ERCP [15.1% (95%CI: 9.40–20.8); I2: 87.1%], and EDGE [13.1% (95%CI: 7.50–18.8); I2: 48.2%], significantly differing from EA-ERCP [5.7% (95%CI: 4.50–6.80); p ≤ 0.04; I2: 64.2%]. Conclusions: LA-ERCP and EDGE were associated with higher technical, cannulation, and therapeutic success compared to EA-ERCP, though accompanied with more adverse events.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Comparison between Enteroscopy-, Laparoscopy- and Endoscopic Ultrasound-Assisted Endoscopic Retrograde Cholangio-Pancreatography in Patients with Surgically Altered Anatomy: A Systematic Review and Meta-Analysis

Gkolfakis

Papaefthymiou

Facciorusso

et al. 2022

Life

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“…Reports of case series on transgastric ERCP have been published recently ( 4 , 7 , 14 , 15 ). Although no study has presented a control group, the technique is consistently reported as being safe and feasible in most situations.…”

Section: Discussionmentioning

confidence: 99%

Management of Common Bile Duct Stones Encountered During Cholecystectomy in Patients With Previous Gastric Bypass

et al. 2021

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Background: Rapid weight loss following gastric bypass (GBP) predisposes to the development of gallstones, and in those who develop gallstone disease there is a high prevalence of common bile duct stones (CBDS). Furthermore, in these patients, CBDS are difficult to extract due to the altered upper gastrointestinal anatomy following GBP. The aim of the present study was to assess outcome after various management methods applied in the counties of Stockholm and Uppsala, Sweden.Methods: Data from the Swedish Register for Gallstone Surgery and ERCP (GallRiks) and the Swedish Obesity Surgery Register (SoReg) were crossmatched to identify all patients who had undergone gallstone surgery after GBP, where CBDS were found at intraoperative cholangiography, in the Stockholm and Uppsala counties 2009–2013. A retrospective review of patient records was performed for all patients identified.Results: In all, 55 patients were identified. These were managed as follows: expectancy (N = 11); transgastric ERCP (N = 2); laparoscopic choledochotomy (N = 3); open choledochotomy (N = 5); transcystic stone extraction (N = 12); and other approach (N = 13). In nine cases, data on management could not be found. There were nine cases of minor postoperative complication. No retained stones were registered. The operation time was longer for transgastric ERCP (p = 0.002), and the postoperative stay was longer following open and laparoscopic choledochotomy (p < 0.001). There was no statistically significant difference between any of the methods regarding the incidence of postoperative complications (p = 0.098).Discussion: Further development of techniques for managing CBDS discovered in patients undergoing cholecystectomy after previous GBP are needed, as well as more comparative studies with greater statistical power.

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“…Se han descrito diferentes procedimientos que han reportado ser efectivos 10,11 , pero hasta la fecha, la técnica de la CPRE-LA, no ha sido estandarizada. En nuestro primer paciente, similar a lo descrito por el doctor Molina-Romero 12 , se realizó un anclaje del estómago a la pared abdominal en el puerto epigástrico, por donde se introdujo el duodenoscopio; esta técnica dificultó su maniobrabilidad de manera importante, por lo que se modificó, dejando el remanente gástrico sin fijación.…”

Section: Técnica Quirúrgicaunclassified

Colangiopancreatografía endoscópica asistida por laparoscopia para el tratamiento de coledocolitiasis en pacientes con Y de Roux

López-Uribe¹,

Naranjo-Salazar²,

Botero³

et al. 2023

Rev Colomb Cir

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Introducción. Los pacientes con antecedente de baipás gástrico que presentan coledocolitiasis no pueden ser tratados con la técnica convencional de colangiopancreatografía retrógrada endoscópica. En estos casos, la vía transgástrica abierta o asistida por laparoscopia, se convierte en una excelente alternativa a la exploración abierta de la vía biliar. Métodos. Estudio retrospectivo que incluyó pacientes adultos con coledocolitiasis y antecedente de gastrectomía subtotal o baipás gástrico con Y de Roux, llevados a colangiopancreatografía endoscópica transgástrica laparoasistida, entre enero de 2019 y diciembre de 2021, en la Clínica CES de Medellín, Colombia. Resultados. Se encontraron siete pacientes, todos con antecedente de baipás gástrico para el manejo de la obesidad. La tasa de identificación y canulación de la vía biliar y extracción de cálculos fue del 100 % mediante el abordaje transgástrico laparo-asistido. Conclusión. De acuerdo con varias revisiones sistemáticas, esta técnica es relativamente fácil de implementar y segura, presentando una tasa de complicaciones inferior a 5 %. Se propone una variante de esta técnica.

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Laparoscopic-Assisted Endoscopic Retrograde Cholangiopancreatography (ERCP) for Bile Duct Stones After Roux-en-Y-Gastric Bypass: Single-Centre Experience

Cited by 9 publications

References 15 publications

Comparison between Enteroscopy-, Laparoscopy- and Endoscopic Ultrasound-Assisted Endoscopic Retrograde Cholangio-Pancreatography in Patients with Surgically Altered Anatomy: A Systematic Review and Meta-Analysis

Comparison between Enteroscopy-, Laparoscopy- and Endoscopic Ultrasound-Assisted Endoscopic Retrograde Cholangio-Pancreatography in Patients with Surgically Altered Anatomy: A Systematic Review and Meta-Analysis

Management of Common Bile Duct Stones Encountered During Cholecystectomy in Patients With Previous Gastric Bypass

Colangiopancreatografía endoscópica asistida por laparoscopia para el tratamiento de coledocolitiasis en pacientes con Y de Roux

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