Laparoscopy-assisted versus balloon enteroscopy-assisted ERCP after Roux-en-Y gastric bypass

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery
• Bariatric Surgery Outcomes

Background:

• Roux-en-Y gastric bypass (RYGB) surgery increases the risk of biliary diseases.
• Endoscopic retrograde cholangiopancreatography (ERCP) is often required for these biliary complications.
• Laparoscopy-assisted ERCP (LA-ERCP) and balloon enteroscopy-assisted ERCP (BEA-ERCP) are primary methods for ERCP post-RYGB.

Purpose of the Study:

• To compare the efficacy and safety of LA-ERCP versus BEA-ERCP in patients who have undergone RYGB.
• To evaluate procedure success rates, benefits, and potential harms associated with each ERCP approach.

Main Methods:

• A retrospective study of RYGB patients undergoing ERCP between May 2013 and December 2017 at two Norwegian centers.
• One center utilized BEA-ERCP, while the other performed LA-ERCP.
• Success was defined by achieving the diagnostic or therapeutic goal; adverse events were graded using the Clavien-Dindo system.

Main Results:

• A total of 79 procedures (40 BEA-ERCP, 39 LA-ERCP) were performed on 68 patients.
• LA-ERCP showed a higher success rate (87.2%) compared to BEA-ERCP (72.5%), though not statistically significant (P=0.14).
• Adverse event rates were 28% for LA-ERCP and 18% for BEA-ERCP (P=0.23); serious adverse events were 7.7% and 2.5%, respectively.

Conclusions:

• Both LA-ERCP and BEA-ERCP are effective in experienced hands for managing biliary issues after RYGB.
• The selection of ERCP technique should be tailored to individual patient factors and the expertise available.
• LA-ERCP procedure times were longer when combined with cholecystectomy.