Laparoscopy-assisted versus balloon enteroscopy-assisted ERCP in bariatric post-Roux-en-Y gastric bypass patients

Gastrointest Endosc. 2012 Apr;75(4):748-56. doi: 10.1016/j.gie.2011.11.019. Epub 2012 Jan 31.

Abstract

Background: Data on balloon enteroscopy-assisted ERCP (BEA-ERCP) versus laparoscopy-assisted ERCP (LA-ERCP) in post-Roux-en-Y gastric bypass (RYGB) patients are lacking.

Objectives: To compare BEA-ERCP with LA-ERCP in post-RYGB patients and to identify factors that predict therapeutic success with BEA-ERCP.

Design: Retrospective chart review.

Setting: A single North American tertiary referral center.

Patients: The review included 56 bariatric post-RYGB patients who underwent ERCP.

Interventions: BEA-ERCP or LA-ERCP.

Main outcome measurements: Cannulation rate, therapeutic success, hospital stay, complications, procedure duration, endoscopist time, and cost.

Results: A total of 32 patients underwent BEA-ERCP, and 24 underwent LA-ERCP. LA-ERCP was superior to BEA-ERCP in papilla identification (100% vs 72%, P = .005), cannulation rate (100% vs 59%, P < .001), and therapeutic success (100% vs 59%, P < .001). The total procedure time was shorter (P < .001) and endoscopist time was longer (P = .006) for BEA-ERCP. There was no difference in postprocedure hospital stay (P = .127) or complication rate (P = .392) between the 2 groups. In the BEA-ERCP group, in patients having a Roux limb + biliopancreatic (from ligament of Treitz to jejunojejunal anastomosis), a limb length less than 150 cm was associated with therapeutic success. Starting with BEA-ERCP and continuing with LA-ERCP after a failed BEA-ERCP saved $1015 compared with starting with LA-ERCP.

Limitations: Single center, retrospective study.

Conclusions: In centers with expertise in deep enteroscopy and ERCP, post-RYGB patients with a Roux + ligament of Treitz to jejunojejunal anastomosis limb length less than 150 cm should first be offered deep enteroscopy-assisted ERCP. In patients with Roux + ligament of Treitz to jejunojejunal anastomosis (LTJJ) limb length 150 cm or longer, LA-ERCP should be the preferred approach because of the lack of need for a second procedure, equivalent morbidity and hospital stay, decreased endoscopist time, and decreased cost.

Publication types

  • Comparative Study

MeSH terms

  • Adenocarcinoma / diagnosis*
  • Ampulla of Vater
  • Anastomosis, Roux-en-Y / adverse effects*
  • Calculi / diagnosis
  • Calculi / therapy
  • Chi-Square Distribution
  • Cholangiopancreatography, Endoscopic Retrograde / economics
  • Cholangiopancreatography, Endoscopic Retrograde / methods*
  • Choledocholithiasis / diagnosis
  • Choledocholithiasis / therapy
  • Common Bile Duct Diseases / diagnosis
  • Common Bile Duct Diseases / therapy
  • Constriction, Pathologic / diagnosis
  • Constriction, Pathologic / therapy
  • Costs and Cost Analysis
  • Double-Balloon Enteroscopy* / adverse effects
  • Double-Balloon Enteroscopy* / economics
  • Female
  • Gastric Bypass / adverse effects
  • Humans
  • Laparoscopy* / adverse effects
  • Laparoscopy* / economics
  • Male
  • Middle Aged
  • Pancreatic Ducts
  • Pancreatic Neoplasms / diagnosis*
  • Retrospective Studies