Laparoscopy-assisted versus balloon enteroscopy-assisted ERCP in bariatric post-Roux-en-Y gastric bypass patients.
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.


OBJECTIVE
To compare BEA-ERCP with LA-ERCP in post-RYGB patients and to identify factors that predict therapeutic success with BEA-ERCP.


METHODS
Retrospective chart review.


METHODS
A single North American tertiary referral center.


METHODS
The review included 56 bariatric post-RYGB patients who underwent ERCP.


METHODS
BEA-ERCP or LA-ERCP.


METHODS
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.


CONCLUSIONS
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.
Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington 98111, USA.
Mitchal A
MA
Schreiner
Lily
L
Chang
Michael
M
Gluck
Shayan
S
Irani
S Ian
SI
Gan
John J
JJ
Brandabur
Richard
R
Thirlby
Ravi
R
Moonka
Richard A
RA
Kozarek
Andrew S
AS
Ross
D000230:Adenocarcinoma / Q000175:diagnosis*; D014670:Ampulla of Vater; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects*; D002137:Calculi / Q000175:diagnosis / Q000628:therapy; D016009:Chi-Square Distribution; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000191:economics / Q000379:methods*; D042883:Choledocholithiasis / Q000175:diagnosis / Q000628:therapy; D003137:Common Bile Duct Diseases / Q000175:diagnosis / Q000628:therapy; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000628:therapy; D003365:Costs and Cost Analysis; D058582:Double-Balloon Enteroscopy / Q000009:adverse effects / Q000191:economics; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts; D010190:Pancreatic Neoplasms / Q000175:diagnosis*; D012189:Retrospective Studies