Laparoscopy-assisted transgastric endoscopic retrograde cholangiopancreatography: Preliminary experience and technique description - 16/03/19

Doi : 10.1016/j.jviscsurg.2019.02.009

S. Tzedakis ^a,^d, R. Memeo ^a,^b,^c,^⁎ , M. Nedelcu ^a,^d, M. Rodriguez ^d, M. Delvaux ^a,^d, J. Huppertz ^a,^d, H. Jeddou ^a,^d, D. Mutter ^a,^b,^d, J. Marescaux ^a,^b, P. Pessaux ^a,^b,^d
^a IRCAD, Research institute against cancer of the digestive system, 67000 Strasbourg, France
^b IHU-Strasbourg, institute for image-guided surgery, 67000 Strasbourg, France
^c Department of Emergency and Organ Transplantation, University of Bari, 70100 Bari, Italy
^d Department of digestive surgery, university hospital of Strasbourg, 67000 Strasbourg, France

^⁎Corresponding author. Hepato-biliary and pancreatic surgical unit, general, digestive, and endocrine surgery, IRCAD, IHU MixSurg, institute for minimally invasive image-guided surgery, university of Strasbourg, 1, place de l’hôpital, 67091 Strasbourg, France.Hepato-biliary and pancreatic surgical unit, general, digestive, and endocrine surgery, IRCAD, IHU MixSurg, institute for minimally invasive image-guided surgery, university of Strasbourg1, place de l’hôpitalStrasbourg67091France

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Summary

Introduction

Common bile duct lithiasis after Roux-en-Y gastric bypass (RYGB) or upper gastrointestinal stenosis has become a challenging problem nowadays, especially as obesity surgery is increasing. In this study, we assess the feasibility and performance of laparoscopy-assisted transgastric endoscopic retrograde cholangiopancreatography (LAERCP) and describe its technique.

Methods

A retrospective review of a prospectively collected database of consecutive patients undergoing a LAERCP between February 2014 and May 2015 was performed at a single institution. Indications were common bile duct lithiasis associated with acute or past episodes of cholangitis and pancreatitis. Endoscopic access to the gastric remnant was obtained laparoscopically.

Results

In total 5 cases were identified. Four of them had undergone a RYGB and one of them presented a benign esophageal peptic stenosis, not allowing peroral gastric access. Biliary cannulation using LAERCP associated with sphincterotomy and stone extraction was successfully achieved in all patients. Mean duration of the entire procedure was 134minutes (range: 66–200min). No early major complications were observed and the mean postoperative hospital stay was 4 days (range: 2–5 days).

Conclusions

LAERCP is a safe and successful procedure for the treatment of common bile duct lithiasis when conventional biliary access is not feasible, notably after RYGB. Larger trials still need to be performed to evaluate efficacy, technical success, and complications related to this technique.

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Keywords : Laparoscopy-assisted transgastric ERCP (LAERCP), Roux-en-Y gastric bypass (RYGB), Esophageal stenosis, Transgastric access ERCP