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Surgical Endoscopy
Published in: Surgical Endoscopy 12/2020

01-12-2020 | Laparoscopy

Tailored access to the hepatobiliary system in post-bariatric patients: a tertiary care bariatric center experience

Authors: Dino Kröll, Alexandra Charlotte Müller, Philipp C. Nett, Reiner Wiest, Johannes Maubach, Guido Stirnimann, Daniel Candinas, Yves Michael Borbély

Published in: Surgical Endoscopy | Issue 12/2020

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Abstract

Background

In bariatric surgery patients, pancreaticobiliary access via endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging and the optimal approach for the evaluation and treatment of biliary tree-related pathologies has been debated. Besides laparoscopy-assisted ERCP (LA-ERCP) as standard of care, EUS-directed transgastric ERCP (EDGE) and hepaticogastrostomy (HGS) with placement of a fully covered metal stent have emerged as novel techniques. The objective of this study was to evaluate safety and efficacy of three different endoscopic approaches (LA-ERCP, EDGE, and HGS) in bariatric patients.

Methods

In this retrospective review, consecutive patients with Roux-en-Y gastric bypass (RYGB) and Sleeve Gastrectomy (SG) who underwent from 2013 to 2019 a LA-ERCP, an EDGE, or a HGS at a tertiary care reference center for bariatric surgery were analyzed. Patient demographics, type of procedure and indication, data regarding cannulation and therapeutic intervention of the common bile duct (procedure success), and clinical outcomes were analyzed.

Results

A total of 19 patients were included. Indications for LA-ERCP, EDGE, or HGS were mostly choledocholithiasis (78.9%) and in a few cases papillitis stenosans. Eight patients (57.1%) with LA-ERCP underwent concomitant cholecystectomy. Procedure success was achieved in 100%. Adverse events (AEs) were identified in 15.7% of patients (all ERCP related). All AEs were rated as moderate and there were no serious AEs.

Conclusion

This case series indicates that ERCP via a transgastric approach (LA-ERCP, EDGE, or HGS) is a minimally invasive, effective, and feasible method to access the biliary tree in bariatric patients. These techniques offer an appealing alternative treatment option compared to percutaneous transhepatic cholangiography and drainage- or deep enteroscopy-assisted ERCP. In bariatric patients who earlier had a cholecystectomy, EUS-guided techniques were the preferred treatment options for biliary pathologies.
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Metadata
Title
Tailored access to the hepatobiliary system in post-bariatric patients: a tertiary care bariatric center experience
Authors
Dino Kröll
Alexandra Charlotte Müller
Philipp C. Nett
Reiner Wiest
Johannes Maubach
Guido Stirnimann
Daniel Candinas
Yves Michael Borbély
Publication date
01-12-2020
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 12/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-019-07343-3

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