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Surgical Endoscopy

Published in:

01-07-2015

Complications of laparoscopic transgastric ERCP in patients with Roux-en-Y gastric bypass

Authors: Kevin L. Grimes, Victor H. Maciel, Wilmer Mata, Gabriel Arevalo, Kirpal Singh, Maurice E. Arregui

Published in: Surgical Endoscopy | Issue 7/2015

Abstract

Background

The altered anatomy of Roux-en-Y gastric bypass presents a challenge when duodenal access is required for ERCP. One technique, laparoscopic transgastric ERCP, was first described in 2002. Since that time, a total of 77 laparoscopic or percutaneous transgastric ERCPs have been reported. The largest case series includes 26 ERCPs, and no reports specifically address complications. We reviewed our experience with 85 transgastric ERCPs and report the limitations and complications associated with access and ERCP.

Methods

Retrospective review was conducted of gastric bypass patients who underwent transgastric ERCP in our practice from 2004–2014.

Results

Forty-one patients underwent 85 transgastric ERCPs during the study period. Conversion from laparoscopic to open procedure occurred in 4.8 %, and selective cannulation rate was 93 %. Forty-seven percent of cases were repeat ERCPs performed through a gastrostomy tube tract. During 15-month median follow-up, the overall complication rate was 19 %, with 88 % of complications related to access rather than ERCP. Most complications were minor; there were no deaths or cases of severe pancreatitis. Additional intervention, including repair of a posterior stomach laceration or transfusion for bleeding, occurred in 4.7 % of cases. Operative intervention occurred in two cases: repair of a duodenal perforation, and debridement of an abdominal wall abscess. Post-ERCP hyperamylasemia was common but did not result in increased length of stay or significant clinical pancreatitis.

Conclusions

Roux-en-Y gastric bypass eliminates the normal approach to the duodenum for ERCP. Transgastric access has a high rate of successful cannulation but is associated with complications. Conversion to open procedure occurred in 4.8 %, and 16 % developed a complication related to the access site, though the rate of operative intervention was low (2.4 %). Our study is limited by its retrospective design, which may underestimate the complication rate, and by our homogenous patient population (94 % female, 68 % sphincter of Oddi dysfunction).

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Title: Complications of laparoscopic transgastric ERCP in patients with Roux-en-Y gastric bypass
Authors: Kevin L. Grimes
Victor H. Maciel
Wilmer Mata
Gabriel Arevalo
Kirpal Singh
Maurice E. Arregui
Publication date: 01-07-2015
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 7/2015
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-014-3901-3

At a glance: The STEP trials

Springer Medicine

Complications of laparoscopic transgastric ERCP in patients with Roux-en-Y gastric bypass

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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