Systematic review of transgastric ERCP in Roux-en-Y gastric bypass patients.
Balloon-assisted endoscopic retrograde cholangiopancreatoscopy (ERCP) in Roux-en-Y gastric bypass (RYGB) patients is technically challenging due to anatomic and accessory constraints, thus success rates are modest. Transgastric ERCP (TG-ERCP) offers a viable alternative. We aimed to systematically review the literature on TG-ERCP in RYGB patients to better define the technical approaches, success rates, and adverse events of this procedure. A computer-assisted search of the Embase and PubMed databases was performed to identify studies that focused on the techniques and clinical outcomes of TG-ERCP. Two investigators independently identified studies and abstracted relevant data. The literature search yielded 26 eligible studies comprising 509 TG-ERCP cases. Access to the excluded stomach to facilitate ERCP was achieved laparoscopically in 58% of reported cases, via open surgery (6% of reported cases), by antecedent placement of a percutaneous gastrostomy tube (33%), or with endoscopic ultrasound assistance (3%). Successful gastric access was reported in 100% of cases and successful ductal cannulation in 98.5%. Adverse events were reported in 14% of cases; 80% of these were related to gastrostomy creation and the rest were attributable to ERCP. Wound infections (n = 19, 3.7%) were the most common gastrostomy-related adverse event, and post-ERCP pancreatitis (n = 7, 1.4%) was the most common ERCP-related adverse event. No deaths were reported. Based on existing observational studies, TG-ERCP appears to be a safe and highly effective approach in patients with RYGB anatomy. Additional research and clinical experience are needed to more precisely define the risk-benefit ratio and optimal technique of TG-ERCP.
Division of Gastroenterology and Hepatology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina. Electronic address: nbanerjee80@gmail.com.
Nikhil
N
Banerjee
Division of Gastroenterology, Department of Medicine, Loyola University Medical Center, Maywood, Illinois.
Mayur
M
Parepally
Division of Gastrointestinal and Laparoscopic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina.
T Karl
TK
Byrne
Division of Gastrointestinal and Laparoscopic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina.
Rana C
RC
Pullatt
Division of Gastroenterology and Hepatology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
Gregory A
GA
Coté
Division of Gastroenterology and Hepatology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
B Joseph
BJ
Elmunzer
D001660:Biliary Tract Diseases / Q000517:prevention & control; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods*; D015905:Gastric Balloon; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods*; D005774:Gastrostomy / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D016896:Treatment Outcome
Bariatric surgery; ERCP; Roux-en-Y gastric bypass surgery