Laparoscopic assisted ERCP in patient with Roux-en-Y gastric bypass. A case report

Mazzeo, Carmelo; Badessi, Giorgio; Pallio, Socrate; Cucinotta, Eugenio

doi:10.1016/j.ijscr.2021.105837

Cited by 3 publications

(7 citation statements)

References 19 publications

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“…Even if the underwater technique is primarily used to perform colonoscopy, the underwater-ERCP using a cap-assisted pediatric colonoscope was recently proposed in six patients with altered anatomy as an alternative, achieving a success rate of 100% without any AEs [ 19 ]. Furthermore, many case reports have been published during the last decade, showing alternative techniques for ERCP in different scenarios, varying from management of Mirizzi syndrome in Billroth II reconstruction to cholangiocarcinoma in RYGB [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. In 2006, the short length double-balloon enteroscopy (s-DBE) was firstly used to perform ERCP in RYGB patients [ 28 ].…”

Section: Resultsmentioning

confidence: 99%

Biliopancreatic Endoscopy in Altered Anatomy

Tarantino

Rizzo

2021

Medicina

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Background and Objectives: Anatomical post-surgical alterations of the upper gastrointestinal (GI) tract have always been challenging for performing diagnostic and therapeutic endoscopy, especially when biliopancreatic diseases are involved. Esophagectomy, gastrectomy with various reconstructions and pancreaticoduodenectomy are among the most common surgeries causing upper GI tract alterations. Technological improvements and new methods have increased the endoscopic success rate in these patients, and the literature has been rapidly increasing over the past few years. The aim of this systematic review is to identify evidence on the available biliopancreatic endoscopic techniques performed in the altered post-surgical anatomy of upper GI tract. Materials and Methods: We performed a systematic search of PubMed, MEDLINE, Cochrane Library, and SCOPUS databases. Study-level variables extracted were the last name of the first author, publication year, study design, number of patients, type of post-surgical anatomical alteration, endoscopic technique, success rate and endoscopic-related adverse events. Results: Our primary search identified 221 titles, which was expanded with studies after the citation search. The final full-text review process identified 52 articles (31 retrospective studies, 8 prospective studies and 13 case reports). We found several different techniques developed over the years for biliopancreatic diseases in altered anatomy, in order to perform both endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). They included enteroscopy-assisted ERCP (double and single balloon enteroscopy-ERCP, spiral enteroscopy-ERCP) laparoscopic assisted ERCP, EUS-Directed transgastric ERCP, EUS-directed transgastric intervention, gastric access temporary for endoscopy, and percutaneous assisted trans prosthetic endoscopic therapy. The success rate was high (most of the techniques showed a success rate over 90%) and a low rate of adverse events were reported. Conclusions: We suggest the considerationof the novel techniques when approaching patients with altered anatomy who require biliopancreatic endoscopy, focusing on the surgery type, success rate and adverse events reported in the literature.

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Section: Resultsmentioning

confidence: 99%

Biliopancreatic Endoscopy in Altered Anatomy

Tarantino

Rizzo

2021

Medicina

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“…The association between an extreme weight loss from gastric bypass and the increased risk of developing biliary disorders is well established [4][5][6][7] . However, prophylactic cholecystectomy is still controversial 1,3,5 . Some authors reported an increased risk of postoperative complications due to technical surgery issues, such as surrounding visceral fat and sub-optimal placement of the ports and a significantly longer operative time when cholecystectomy is performed simultaneously 3,6,8 .…”

Section: Discussionmentioning

confidence: 99%

“…However, prophylactic cholecystectomy is still controversial 1,3,5 . Some authors reported an increased risk of postoperative complications due to technical surgery issues, such as surrounding visceral fat and sub-optimal placement of the ports and a significantly longer operative time when cholecystectomy is performed simultaneously 3,6,8 . Only patients with biliary symptoms in the past or at time of bariatric surgery should be submitted to cholecystectomy 9,10 .…”

Section: Discussionmentioning

confidence: 99%

“…However, these procedures are not free from complications. Due to fast weight loss and long fasting, patients who have undergone bariatric procedures are in a greater risk of developing cholelithiasis and choledocholithiasis 1,3,4 . In fact, 33% of the patients may develop gallstones and up to 15% will require cholecystectomy for gallstones-related complaints 1 .…”

Section: Introductionmentioning

confidence: 99%

“…In fact, 33% of the patients may develop gallstones and up to 15% will require cholecystectomy for gallstones-related complaints 1 . Treatment of choledocholithiasis in these patients is an issue since transoral endoscopic retrograde cholangiopancreatography (ERCP) is not possible in result of the upper gastrointestinal tract anatomy distortion 3 . Therefore, other methods must be used to access the biliary tree, such as laparoscopic-assisted transgastric endoscopic retrograde cholangiopancreatography (LAERCP) 5 .…”

Section: Introductionmentioning

confidence: 99%

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Cpre Transgástrica Assistida Por Laparoscopia Em Paciente Com Bypass Gástrico De Anastomose Única: Relato De Caso

Pereira¹,

Patrocínio²,

Reis³

et al. 2022

Relatos Casos Cir.

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Introdução: A alta incidência de colelitíase e coledocolitíase está associada à rápida perda de peso alcançada pela cirurgia bariátrica. No entanto, o acesso à árvore biliar pode ser muito desafiador para cirurgiões e endoscopistas após um bypass gástrico. Relato do caso: Uma paciente de 66 anos de idade, com história de bypass gástrico de anastomose única, recorreu ao serviço de urgência com coledocolitíase. Devido à anatomia gastrointestinal distorcida, o acesso convencional à árvore biliar não foi possível. A paciente foi submetida a colangiopancreatografia endoscópica retrógrada (CPRE) transgástrica assistida por laparoscopia, na qual um endoscópio é introduzido no estômago excluído por via laparoscópica. A cirurgia é descrita passo a passo a seguir. Nenhuma complicação foi registrada. Conclusão: Este procedimento está a tornar-se mais comum devido ao aumento do número de cirurgias bariátricas. Este caso mostrou que a técnica descrita é simples, segura e viável, mesmo em hospitais secundários, com o benefício adicional de permitir tratamento endoscópico e colecistectomia ao mesmo tempo. Palavras-chave: Colangiopancreatografia Retrógrada Endoscópica. Laparoscopia; Coledocolitíase. Derivação Gástrica.

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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 ERCP in patient with Roux-en-Y gastric bypass. A case report

Cited by 3 publications

References 19 publications

Biliopancreatic Endoscopy in Altered Anatomy

Biliopancreatic Endoscopy in Altered Anatomy

Cpre Transgástrica Assistida Por Laparoscopia Em Paciente Com Bypass Gástrico De Anastomose Única: Relato De Caso

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

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