Efficacy and Safety of 100 Laparoscopy-Assisted Transgastric Endoscopic Retrograde Cholangiopancreatography Procedures i
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ORIGINAL CONTRIBUTIONS
Efficacy and Safety of 100 Laparoscopy-Assisted Transgastric Endoscopic Retrograde Cholangiopancreatography Procedures in Patients with Roux-en-Y Gastric Bypass Lieke M. Koggel 1 & Peter J. Wahab 1 & Rob J. Robijn 1 & Theo J. Aufenacker 2 & Bart P. L. Witteman 2 & Marcel J. M. Groenen 1 & Jan M. Vrolijk 1 Received: 5 June 2020 / Revised: 17 August 2020 / Accepted: 18 August 2020 # The Author(s) 2020
Abstract Purpose Laparoscopy-assisted transgastric endoscopic retrograde cholangiopancreatography (LAERCP) is an alternative for the anatomically challenging conventional ERCP in patients with a Roux-en-Y gastric bypass (RYGB) as it allows access to the biliary tree via the gastric remnant. We investigated the efficacy and safety of LAERCP. Material and Methods We retrospectively reviewed all charts from RYGB patients who underwent a LAERCP between January 2009 and August 2019 in a non-academic referral center for bariatric surgery. Patients who underwent pancreatic therapy were excluded. We collected demographic, clinical, and outcome data. An adverse event was defined as any complaint related to the LAERCP up to 30 days after the procedure and graded according to the ASGE lexicon. Results We identified 100 LAERCP in 86 patients with RYGB (70% female, median age 54 years). Same-session cholecystectomy was performed in 35 LAERCP (35%). The papilla of Vater was visualized in 100% of LAERCP with a therapeutic success rate of 94%. Stone extraction succeeded in 88.8% and sphincterotomy was performed in 96.7%. We identified 30 adverse events in 28 procedures, of which eight endoscopy-related, 14 laparoscopy-related, and eight non-specified (f.i. fever, allergic reaction). In total, six severe adverse events were reported concerning post-ERCP pancreatitis (n = 2), laparoscopy-related hemorrhage (n = 1), abscess (n = 1), shock (n = 1), and pneumonia (n = 1). No patient died due to LAERCP. Conclusion LAERCP is an effective and relatively safe procedure for biliary diseases in patients with RYGB. Keywords ERCP . Choledocholithiasis . Laparoscopy . Bariatric surgery . Gastric bypass
Introduction Obesity is a major and increasing health burden affecting up to 15% of all adults worldwide [1]. Those who are morbidly obese are at greater risk for diseases including diabetes, cardiovascular disease, sleep apnea, gallstones, osteoarthritis, and cancer [1, 2]. Bariatric surgery has been expanding over the last years as it is the most successful option for lasting weight reduction in people who have not had success with diet and exercise. The most performed bariatric surgery in * Jan M. Vrolijk [email protected] 1
Department of Gastroenterology and Hepatology, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands
2
Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
The Netherlands is a laparoscopic Roux-en-Y gastric bypass (RYGB), in which the size of the stomach is reduced (pouch) and a part of the small intestine is bypassed (on average 1/3 of the total length). During weig
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