Temporary Trans-gastric Stent Deployment Over a 20 French Gastrostomy for Single-Stage Endoscopic Retrograde Cholangiopa
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Temporary Trans-gastric Stent Deployment Over a 20 French Gastrostomy for Single-Stage Endoscopic Retrograde Cholangiopancreatography After Gastric Bypass Gianfranco Donatelli 1 Jean-Loup Dumont 1
&
Fabrizio Cereatti 1,2 & Andrea Spota 1,3 & Thierry Tuszynski 1 & David Danan 1 &
Received: 21 May 2020 / Revised: 8 July 2020 / Accepted: 8 July 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Introduction Treatment of pancreato-biliary disorders after gastric bypass is challenging due to altered anatomy. Several techniques have been proposed to overcome this condition; however, none has emerged as the gold standard treatment. Furthermore, a decision-making algorithm evaluating when and why apply one technique over another is still lacking. Objectives To describe a novel trans-gastric approach to allow endoscopic retrograde cholangiopancreatography (ERCP) in Roux-en-Y gastric bypass (RYGB) anatomy soon after prior laparoscopic cholecystectomy (LC) and to propose a decisionmaking algorithm for selection of the most suitable technique according a tailored approach. Setting Private hospital. Methods Between January and March 2020, patients with Roux-en-Y gastric bypass anatomy referred to our tertiary center to undergo ERCP after recent laparoscopic cholecystectomy were retrospectively evaluated. A 20 french (Fr) gastrostomy was performed during cholecystectomy. A single-stage ERCP was carried out by means of temporary trans-gastric stent deployment over a 20 Fr gastrostomy. Results A total of 5 patients (mean age 41; mean body mass index 48.3) were enrolled. ERCP was performed after an average of 2 days from surgery. Technical and clinical success was achieved in 100%. No adverse events occurred. Spontaneous closure of the gastrostomy after its bedside removal was observed in all cases. Conclusions Our approach allows to perform a single-stage ERCP in RYGB patients, early after LC, with no need of any other reinterventions. Any surgeon facing unexpected biliary disorders, during LC, can easily perform a 20 Fr gastrostomy thus allowing the patient to undergo early ERCP without any delay. Keywords Gastrostomy . SEMS . ERCP . RYGB . CBD stones . Laparoscopic cholecystectomy
Introduction Laparoscopic Roux-en-Y gastric-by-pass (RYGB) is one of the most commonly performed bariatric procedures
* Gianfranco Donatelli [email protected] 1
Unité d’Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé, 8 Place de l’Abbé G. Hénocque, 75013 Paris, France
2
Gastroenterologia ed Endoscopia Digestiva ASST Cremona, Cremona, Italy
3
Scuola di Specializzazione in Chirurgia Generale, Università degli studi di Milano, Milan, Italy
worldwide [1]. Both morbid obesity and rapid weight loss are known risk factors for development of gallstone and choledocolithiasis. It has been reported that up to 36% [2] patients develop gallstone after RGBY and, that 5.3% patients with choledocholithiasis will require pancreato-biliary interventions [3]. Furthermore, morbid
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