Endoscopic retrograde cholangiopancreatography (ERCP) approach for patients with Roux-en-Y gastric bypass: a comparative study between four ERCP techniques with proposed management algorithm

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Tipo de produção
article
Data de publicação
2024
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
ELSEVIER SCIENCE INC
Autores
GHAZI, Rabih
RAZZAK, Farah Abdul
KERBAGE, Anthony
STORM, Andrew C.
VARGAS, Eric J.
BOFILL-GARCIA, Aliana
CHANDRASEKHARA, Vinay
LAW, Ryan J.
MARTIN, John A.
Citação
SURGERY FOR OBESITY AND RELATED DISEASES, v.20, n.1, p.53-61, 2024
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Background: Endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging in patients with Roux-en-Y gastric bypass (RYGB) due to altered anatomy.Objective: To compare the procedural and clinical outcomes of 4 different ERCP techniques in RYGB patients.Setting: Academic tertiary referral center in the United States. Methods: A retrospective cohort study including patients with RYGB anatomy who underwent an ERCP between January 2015 and September 2020. We compared procedural success and adverse events (AEs) rates of balloon-assisted enteroscopy (BAE), gastrostomy-assisted ERCP (GAE), endoscopic ultrasound (EUS)-directed transgastric ERCP (EDGE), and rendezvous guidewire-assisted ERCP (RGA).Results: Seventy-eight RYGB patients underwent a total of 132 ERCPs. The mean age was 60 +/- 11.8 years, with female predominance (85.7%). The ERCP procedures performed were BAE (n = 64; 48.5%), GAE (n = 18; 13.7%), EDGE (n = 25; 18.9%), and RGA (n = 25; 18.9%), with overall procedure success rates of 64.1%, 100%, 89.5%, and 91.7%, respectively. All approaches were superior to BAE (GAE versus BAE, P =.003; EDGE versus BAE, P =.034; RGA versus BAE, P =.011). The overall AE rates were 10.9%, 11.1%, 15.8 %, and 25.0%, respectively. There was no statistical difference in AEs. There were also no differences in bleeding, post-ERCP pancreatitis, and perforation rates between the 4 approaches.Conclusion: Procedure success was similar between GAE, RGA, and EDGE, but superior to BAE. AE rates were similar between approaches. (Surg Obes Relat Dis 2024;20:53-61.) (c) 2024 American Society for Metabolic and Bariatric Surgery.
Palavras-chave
ERCP, Roux-en-Y gastric bypass, Choledocholithiasis, Endoscopic ultrasound, Bariatric surgery
URI
https://observatorio.fm.usp.br/handle/OPI/58201
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Coleções
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - LIM/35