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


OBJECTIVE
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.


METHODS
Retrospective case series.


METHODS
High-volume bariatric surgery center.


METHODS
Consecutive patients undergoing LAERCP between 2003 and 2009.


METHODS
LAERCP.


RESULTS
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).


CONCLUSIONS
Single-center, retrospective design.


CONCLUSIONS
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.
Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, Alabama 35294-0007, USA.
Tercio L
TL
Lopes
Ronald H
RH
Clements
C Mel
CM
Wilcox
D000328:Adult; D050110:Bariatric Surgery; D001660:Biliary Tract Diseases / Q000175:diagnosis* / Q000628:therapy; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000175:diagnosis* / Q000628:therapy; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic; D016896:Treatment Outcome; D014741:Video Recording