Transjejunal Laparoscopic-Assisted ERCP: a Technique to Deal with Choledocholithiasis After Roux-En-Y Reconstruction

Dalmonte, Giorgio; Valente, Marina; Bosi, S.; Gnocchi, Alessandro; Marchesi, Federico

doi:10.1007/s11695-019-03882-9

Cited by 9 publications

(9 citation statements)

References 9 publications

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“…Laparoscopy also allows for inspection and closure of any mesenteric defects. In a subgroup of patients, access to the gastric remnant can be challenging and a transjejunal approach may be an alternative [21].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopy-assisted versus balloon enteroscopy-assisted ERCP after Roux-en-Y gastric bypass

et al. 2020

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Background Patients who have undergone Roux-en-Y gastric bypass (RYGB) are at increased risk of biliary disease necessitating endoscopic retrograde cholangiopancreatography (ERCP). The most widely used approaches to perform ERCP after RYGB are laparoscopy-assisted ERCP (LA-ERCP) and balloon enteroscopy-assisted ERCP (BEA-ERCP). There are few studies comparing these procedures. We aimed to compare the performance, benefits, and harms of LA-ERCP and BEA-ERCP in RYGB patients. Methods We identified all RYGB patients who underwent ERCP at two tertiary care endoscopy centers in Oslo, Norway between May 2013 and December 2017. One center performed BEA-ERCP, the other LA-ERCP. Procedure success was defined as fulfillment of the therapeutic or diagnostic aim, according to the procedure description. Adverse events were classified according to the Clavien–Dindo grading system. Results During the study period, 40 BEA-ERCP and 39 LA-ERCP procedures were performed in 68 patients. Procedure success rate was 72.5 % for BEA-ERCP and 87.2 % for LA-ERCP (P = 0.14). Adverse events occurred in 18 % of BEA-ERCP and 28 % of LA-ERCP (P = 0.23). Serious adverse events (Clavien–Dindo grade ≥ 3b) occurred in 2.5 % of BEA-ERCP and 7.7 % of LA-ERCP procedures (P = 0.36). Concomitant cholecystectomy was performed in 25 of the 39 LA-ERCP procedures. The median procedure times for LA-ERCP performed with and without concomitant cholecystectomy were 201 minutes and 140 minutes, respectively, and for BEA-ERCP was 125 minutes. Conclusions In experienced hands, both LA-ERCP and BEA-ERCP have high success rates after RYGB. The choice of approach should be individualized according to patient characteristics and available physician competence.

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Section: Discussionmentioning

confidence: 99%

Laparoscopy-assisted versus balloon enteroscopy-assisted ERCP after Roux-en-Y gastric bypass

et al. 2020

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“…Endoscope selection is also an important discrepancy among the reported cases. Only two cases have explained their preference towards using a colonoscope in their techniques, which state it has a reduced risk of intestinal injuries due to the limited visual field of side viewing with other endoscopes [3,4]. In our case, side viewing was not an issue, and it even permitted us to localize the bilioenteric anastomosis and provided us the stability for an adequate biliary cannulation.…”

Section: Discussionmentioning

confidence: 79%

“…A single case in a young patient with RYHJ has been reported by Mansor et al, who in contrast to our case, performed bowel exteriorization through the optic port incision as part of their technique for endoscopic cannulation [10]. Two authors have recently addressed the importance of this maneuver to prevent intestinal content spilling into the abdominal cavity during enterotomy creation and to facilitate bowel cannulation, though in their cases it was performed through a mini-laparotomy [3,4].…”

Section: Discussionmentioning

confidence: 94%

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Transjejunal Laparoscopic Assisted ERCP in a Patient with Roux-en-Y Hepaticojejunostomy

et al. 2019

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Background and Objectives: Nowadays, with the increasing laparoscopic expertise and accessibility to modern surgical tools, laparoscopic assisted ERCP (LAERCP) has become an effective approach for the management of bile stone disease in patients with modified gastrointestinal anatomy. In contrast to patients with gastric bypass in whom a transgastric LAERCP approach is usually performed, the resultant anatomy of Roux-en-Y hepaticojejunostomy precludes a gastric approach as the newly formed bilioenteric anastomosis is not reachable through the stomach. Therefore, a transjejunal approach has been described as an alternative LAERCP technique. To the best of our knowledge this is the tenth case of transjejunal LAERCP reported worldwide. Materials and Methods: We present the case of a 50-year-old female with history of biliary injury during a cholecystectomy corrected with Roux-en-Y hepaticojejunostomy who presented to our center with manifestations of acute abdomen. After laboratory and image analysis, diagnosis of intrahepatic lithiasis was confirmed. The decision to perform a transjejunal LAERCP was made due to the complex anatomy in this patient. No complications were found during surgery and in the follow up period. Conclusions: Transjejunal LAERCP is an effective approach for endoscopic management of biliary complications in patients with Roux-en-Y hepaticojejunostomy and other modified gastrointestinal anatomy. Previous recommendations by more experienced teams have been reported, nonetheless, there are too few cases reported to make definitive recommendations and conclusions. In limited settings, such as ours, some of these recommendations may not be applicable. We are certain that, with the increasing expertise and innovations in laparoscopy surgery for the management of complications that cannot be addressed by endoscopic or noninvasive measures, more cases will be reported.

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“…MRCP examination was performed by (3. 0T) nuclear magnetic resonance (NMR) instrument, and if necessary, CT examination was constructed by 16-slice spiral CT (Siemens Ltd, Erlangen, Germany) [13,14] . (2) Serum indexes detection method: Serum indexes:…”

Section: Methodsmentioning

confidence: 99%

Diagnostic Value of Endoscopic Retrograde Cholangiopancreatography Combined with Serum C-Reactive Protein, CEA and IL-6 in Occult Common Bile Duct Stones

Lu¹,

Liu²,

Wu³

2021

Preprint

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Objective: To investigate the diagnostic value of ERCP combined with CRP, CEA and IL-6 in serum in Occult Common bile duct stones (CBDS). Methods: 80 cases of patients with occult CBDS treated in our hospital were selected as the research subjects, and the diagnosis rates of ERCP alone or ERCP combined with CRP, CEA and IL-6 in serum were compared. Results: Versus ERCP alone, the diagnosis rate of combined diagnosis was clearly higher (P < 0.05). Versus patients without CBDS, the levels of CRP, CEA and IL-6 in serum in CBDS patients were apparently elevated (P < 0.05). The levels of CRP, CEA and IL-6 in serum were of high value in the diagnosis of CBDS in patients with occult CBDS (P < 0.05). Conclusion: ERCP combined with CRP, CEA and IL-6 in serum is of high value in re-diagnosis of Occult CBDS.

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Transjejunal Laparoscopic-Assisted ERCP: a Technique to Deal with Choledocholithiasis After Roux-En-Y Reconstruction

Cited by 9 publications

References 9 publications

Laparoscopy-assisted versus balloon enteroscopy-assisted ERCP after Roux-en-Y gastric bypass

Laparoscopy-assisted versus balloon enteroscopy-assisted ERCP after Roux-en-Y gastric bypass

Transjejunal Laparoscopic Assisted ERCP in a Patient with Roux-en-Y Hepaticojejunostomy

Diagnostic Value of Endoscopic Retrograde Cholangiopancreatography Combined with Serum C-Reactive Protein, CEA and IL-6 in Occult Common Bile Duct Stones

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