Laparoscopic-Assisted Transgastric ERCP: A Single-Institution Experience

Abstract

Background Laparoscopic-assisted transgastric endoscopic retrograde cholangiopancreatography (LAERCP) is used for treatment in patients after Roux-en-Y gastric bypass (RYGB), where transoral access to the biliary tree is not possible. We describe our technique and experience with this procedure. Methods Electronic medical record search was performed from September 2012 to January 2016, identifying patients who underwent LAERCP per operative records. Charts were reviewed for demographic, clinical, and outcomes data. Results Sixteen patients were identified. Average time since bypass was 6.9 years, and length of stay was 3.7 days. Five patients underwent simultaneous cholecystectomy. Eleven patients, or 43%, had cholecystectomy more than 2 years previously. ERCP with sphincterotomy was completed in 15 of 16 patients (94%). Our technique involves access to the bypassed stomach via a laparoscopically placed 15 mm port. We observed one major complication of post-ERCP necrotizing pancreatitis. No minor complications nor mortalities were seen in our series. Conclusion Biliary obstruction can occur many years after RYGB and cholecystectomy. Our findings suggest that RYGB patients may be at a higher risk of primary CBD stone formation. LAERCP is a reliable option for common bile duct (CBD) clearance; our technique of LAERCP is technically simple and associated with low complication rate, making it appealing to surgeons not trained in advanced laparoscopy.

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

“…The initial literature search resulted in 4105 studies, with 76 of them [ 11 , 13 , 15 , 17 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 ,…”

“…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 ].…”

Current status of endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy

“…The therapeutic success rate of peroral endoscopic ERCP is very low (59%) using either a pediatric colonoscope or device-assisted ERCP because of adhesion formation, angulation of the jejunojejunal anastomosis, and figure-eight looping of the scope[3,4]. New and challenging techniques in the performance of ERCP are endoscopic ultrasonography (EUS)-guided biliary drainage (EUS-BD) and laparoscopic-assisted transgastric ERCP (LA-ERCP), which have high success rates of 80%-100%[5-7].…”

Laparoscopy-Assisted Transgastric ERCP: A Challenging Technique for Biliary Clearance Post Roux-en-Y Gastric Bypass

“…Average time since RYGB in one series was 6.9 years and 43% of the patients presented 1 to 2 years after initial cholecystectomy. 4 A retrospective review by Brockmeyer et al assessed the biliary complications of RYGB in 1,366 patients, of which 380 had cholecystectomy prior RYGB and only 3 of them (<1%) developed primary CBD stones. This result suggests that RYGB itself can predispose to primary CBD stone, but it is a relatively rare event to occur.…”