Endoscopic retrograde cholangiopancreatography in patients with different types of total and partial gastrectomy

Endoscopic retrograde cholangiopancreatography (ERCP) in surgically altered anatomy patients is challenging. We analyzed ERCP procedures after gastric surgery with maintained Vater's papilla: total/partial gastrectomy Roux-en-Y, Billroth II gastrectomy, sleeve gastrectomy and gastrojejunostomy.

Monocentric retrospective analysis of prospective ERCP cohort in surgically altered gastric anatomy (SAGA) patients with maintained Vater's papilla between 2006 and 2024.

186 ERCP procedures in 110 patients with SAGA proportions: 37% total gastrectomy Roux-en-Y, 32% Billroth II partial gastrectomy, 15% partial gastrectomy Roux-en-Y, 11% gastrojejunostomy, 4% sleeve gastrectomy and 1% less common reconstructions. ERCP indications were mainly biliary (87%). Total technical success was 82% with lower technical success in Roux-en-Y gastric surgery (73%) vs gastric surgery without Rouxen- Y (92%). 13 adverse events (GRADE II - IV) were encountered (7%) with 1 mortality due to perprocedural cardiac arrest. Sleeve gastrectomy allowed the use of conventional duodenoscopes with 100% technical success. In Billroth II patients both duodenoscopes, gastroscopes and colonoscopes as well as balloon-assisted enteroscopes were used with high technical success (94-100%), as well as in gastrojejunostomy patients (57-100%). For Roux-en-Y reconstructions, only single-balloon enteroscopes were used with acceptable success (75% in partial and 74% in total gastrectomy Roux-en-Y).

ERCP in SAGA patients is challenging requiring different types of endoscopes, especially after Roux-en-Y total or partial gastrectomy with lower technical success as compared tods Billroth II gastrectomy, sleeve gastrectomy and gastrojejunostomy. Adverse event rates are comparable to ERCP procedures in patients with normal anatomy.