Laparoscopy–assisted versus balloon enteroscopy–assisted ERCP in bariatric post–Roux-en-Y gastric bypass patients - 21/03/12
Reprint requests: Andrew S. Ross, MD, Virginia Mason Medical Center, 1100 9th Avenue, Mailstop C3-GAS, Seattle, WA 98111Résumé |
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.
Le texte complet de cet article est disponible en PDF.Abbreviations : BEA-ERCP, LA-ERCP, LTJJ, RYGB
Plan
| DISCLOSURE: The following author disclosed financial relationships relevant to this publication: Dr. Kozarek: Olympus America Inc, research and live course support; Boston Scientific, research and live endoscopy course support; Cook Medical, research and live endoscopy course support. The other authors disclosed no financial relationships relevant to this publication. Equipment was donated to Virginia Mason Medical Center by Olympus America Inc. |
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| If you would like to chat with an author of this article, you may contact Dr Ross at andrew.ross@vmmc.org. |
Vol 75 - N° 4
P. 748-756 - avril 2012 Retour au numéro
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