Tailored access to the hepatobiliary system in post-bariatric patients: a tertiary care bariatric center experience

Kröll, Dino; Müller, Alexandra; Nett, Philipp C.; Wiest, Reiner; Maubach, Johannes; Stirnimann, Guido; Candinas, Daniel; Borbély, Yves Michael

doi:10.1007/s00464-019-07343-3

Cited by 11 publications

(19 citation statements)

References 21 publications

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“…All studies presented data concerning AEs [16][17][18][19][20]. The rates of AEs were also comparable between the groups, 13% in the EDGE group and 20.4% in the LA-ERCP group, with a RD -0.08 (95% CI − 0.17 to 0.01; I² = 33%; p = 0.09) (Figure 4).…”

Section: Adverse Events and Serious Adverse Eventsmentioning

confidence: 78%

“…All studies reported technical success [16][17][18][19][20]. The rates of technical success were similar, 97.8% and 98.3% in the EDGE and LA-ERCP groups, respectively, with a RD of 0.00 (95% CI − 0.06 to 0.06; I² = 0%; p = 0.96) (Figure 3).…”

Section: Technical Successmentioning

confidence: 86%

“…Table 3 shows specific data regarding the pool of patients that underwent the EDGE procedure. Fistula closure -performed through some endoscopic adjuvant techniques in most cases -was reported by four studies [16][17][18][19] and was achieved in the majority of patients (85%). Spontaneous fistula closure was achieved in 24% of the cases.…”

Section: Characteristics and Outcomes Of The Edge Procedures Groupmentioning

confidence: 99%

“…All studies [16][17][18][19][20] presented a severe overall risk of bias (Figure 2). The quality of evidence for each outcome is described in Table 2.…”

Section: Risk Of Bias and Quality Of Evidence Assessmentmentioning

confidence: 99%

“…Gastrogastrostomy (GG) was the most common transluminal access to the excluded stomach, followed by jejunogastrostomy (JG). The procedure was performed mainly in two stages, and the 15 mm LAMS was the most commonly employed size stent among studies with available data [16,18].…”

Section: Characteristics and Outcomes Of The Edge Procedures Groupmentioning

confidence: 99%

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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

Oliveira¹,

Júnior²,

Proença³

et al. 2022

Cureus

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Endoscopic retrograde cholangiopancreatography (ERCP) is a therapeutic procedure for skilled endoscopists that can be even more challenging in some situations, including patients' post-Roux-en-y Gastric Bypass (RYGB) surgery. There is still no consensus on whether laparoscopic-assisted ERCP (LA-ERCP) or endoscopic ultrasound (EUS)-directed transgastric ERCP (EDGE) is the most appropriate, safe, and feasible approach in patients with this type of post-surgical anatomy. This systematic review and meta-analysis aimed to examine both approaches' feasibility, efficacy, and safety in this situation.We searched for electronic databases (MEDLINE, EMBASE, Lilacs, Google Scholar, and Central Cochrane) to identify studies comparing LA-ERCP versus EDGE. Outcomes measured included technical success, adverse events (AEs) and serious AEs, length of stay (LOS), and procedural time. Descriptive data related to the EDGE procedure was also extracted. The risk of bias and the quality of evidence of the enrolled studies were assessed.Five studies, totalizing 268 patients (176 LA-ERCP and 92 EDGE), were included. There was no statistical difference in technical success and AEs between groups; however, the LOS and procedural times were shorter for the EDGE group. High rates of fistula closure and no weight regain were observed in EDGE. Both methods are feasible and safe techniques to perform ERCP in patients with RYGB anatomy, with comparable technical success and adverse events rate. However, EDGE is associated with shorter LOS and procedural time.

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Section: Adverse Events and Serious Adverse Eventsmentioning

confidence: 78%

Section: Technical Successmentioning

confidence: 86%

Section: Characteristics and Outcomes Of The Edge Procedures Groupmentioning

confidence: 99%

“…All studies [16][17][18][19][20] presented a severe overall risk of bias (Figure 2). The quality of evidence for each outcome is described in Table 2.…”

Section: Risk Of Bias and Quality Of Evidence Assessmentmentioning

confidence: 99%

Section: Characteristics and Outcomes Of The Edge Procedures Groupmentioning

confidence: 99%

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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

Oliveira¹,

Júnior²,

Proença³

et al. 2022

Cureus

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Management of choledocholithiasis after Roux-en-Y gastric bypass: a systematic review and pooled proportion meta-analysis

et al. 2022

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Safety and efficacy of LA-ERCP procedure following Roux-en-Y gastric bypass: a systematic review and meta-analysis

et al. 2023

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Introduction Rapid weight loss following Roux-en-Y gastric bypass surgery (RYGB) translates to an increased need for endoscopic retrograde cholangiopancreatography (ERCP) intervention. Laparoscopically Assisted Transgastric ERCP (LA-ERCP) has emerged to address the issue of accessing the excluded stomach. This study aims to evaluate the safety and efficacy of LA-ERCP procedure following RYGB. Methods The Cochrane, EMBASE, SCOPUS, MEDLINE, Daily and Epub databases were searched from inception to May 2022 using the PRISMA guidelines. Eligible studies reported participants older than 18 years who underwent the LA-ERCP procedure, following RYGB, and outcomes of patients. Results 27 unique studies met the inclusion criteria with 1283 patients undergoing 1303 LA-ERCP procedures. 81.9% of the patients were female and the mean age was 52.18 ± 13.38 years. The rate of concurrent cholecystectomy was 33.6%. 90.9% of procedures were undertaken for a biliary indication. The mean time between RYGB and LA-ERCP was 89.19 months. The most common intervention performed during the LA-ERCP was a sphincterotomy (94.3%). Mean total operative time was 130.48 min. Mean hospital length of stay was 2.697 days. Technical success was 95.3%, while clinical success was 93.8%. 294 complications were recorded with a 20.6% complication rate. The most frequent complications encountered were pancreatitis (6.8%), infection (6.1%), bleeding (3.4%), and perforation (2.5%). Rate of conversion to open laparotomy was 7%. Conclusion This meta-analysis presents preliminary evidence to suggest the safety and efficacy of LA-ERCP procedure following RYGB. Further investigations are warranted to evaluate the long-term efficacy of this procedure using studies with long-term patient follow-up.

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Tailored access to the hepatobiliary system in post-bariatric patients: a tertiary care bariatric center experience

Cited by 11 publications

References 21 publications

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

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

Management of choledocholithiasis after Roux-en-Y gastric bypass: a systematic review and pooled proportion meta-analysis

Safety and efficacy of LA-ERCP procedure following Roux-en-Y gastric bypass: a systematic review and meta-analysis

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