Gastrointestinal Endoscopy
Volume 70, Issue 6 , Pages 1254-1259, December 2009

Laparoscopy-assisted ERCP: experience of a high-volume bariatric surgery center (with video)

  • Tercio L. Lopes, MD, MSPH

      Affiliations

    • Corresponding Author InformationReprint requests: Tercio L. Lopes, MD, MSPH, Division of Gastroenterology and Hepatology, The University of Alabama at Birmingham, 703 19th Street South, ZRB Room 633, Birmingham, AL 35294-0007.
    • ,
  • Ronald H. Clements, MD
    • ,
  • C. Mel Wilcox, MD, MSPH

Current affiliation: Division of Gastroenterology and Hepatology (T.L.L., C.M.W.) and Section of Gastrointestinal Surgery (R.H.C.), The University of Alabama at Birmingham, Birmingham, Alabama, USA

Received 11 April 2009; accepted 22 July 2009. published online 21 October 2009.

Birmingham, Alabama, USA

Background

Laparoscopy-assisted ERCP (LAERCP) allows the diagnosis and treatment of biliopancreatic conditions in patients with Roux-en-Y anatomy (RY). However, experience with this technique is limited.

Objectives

To report on the experience with LAERCP in consecutive patients from a high-volume bariatric surgery center and to evaluate success rates of ERCP with the laparoscopy-assisted approach.

Design

Retrospective case series.

Setting

High-volume bariatric surgery center.

Patients

Consecutive patients undergoing LAERCP between 2003 and 2009.

Intervention

LAERCP.

Outcomes

Immediate/delayed complications, biliary/pancreatic duct cannulation, endoscopic/laparoscopic interventions, postprocedure hospital stay, procedure duration.

Results

Ten patients underwent LAERCP: 9 after Roux-en-Y gastric bypass (RYGB) and 1 after antrectomy with RY (9 female, 1 male; 9 white, 1 black). Indications for the procedure were choledocholithiasis (n=4), biliary stricture (n=3), and sphincter of Oddi dysfunction (n=3). Endoscopic access was obtained to the gastric remnant (n=9) or biliopancreatic limb (n=1). Biliary cannulation was successfully achieved in 9 of 10 patients, biliary sphincterotomy was performed in all, pancreatography in 3 of 3, and sphincter of Oddi manometry in 2. In 1 patient, a 3F pancreatic duct stent was placed prophylactically. Mild post-ERCP pancreatitis developed in 2 patients, and 1 patient had a pneumothorax intraoperatively that was treated successfully. The mean duration of the procedure was 89 minutes (range 41-245), and the median postprocedure hospital stay was 2 days (mean 2.59, standard deviation 2.46).

Limitations

Single-center, retrospective design.

Conclusion

LAERCP is safe and successful for the diagnosis and therapy of biliopancreatic conditions in patients with RY. It additionally allows the diagnosis and treatment of internal hernias, a known complication of RYGB.

Abbreviations: DBE, double-balloon enteroscope, LAERCP, laparoscopy-assisted ERCP, PTC, percutaneous transhepatic cholangiography, RY, Roux-en-Y anatomy, RYGB, Roux-en-Y gastric bypass, SOD, sphincter of Oddi dysfunction

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 DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

PII: S0016-5107(09)02277-9

doi:10.1016/j.gie.2009.07.035

Gastrointestinal Endoscopy
Volume 70, Issue 6 , Pages 1254-1259, December 2009

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