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

被引：158

作者：

Schreiner, Mitchal A. ^{[1
]}

Chang, Lily ^{[1
]}

Gluck, Michael ^{[1
]}

Irani, Shayan ^{[1
]}

Gan, S. Ian ^{[1
]}

Brandabur, John J. ^{[1
]}

Thirlby, Richard ^{[1
]}

Moonka, Ravi ^{[1
]}

Kozarek, Richard A. ^{[1
]}

Ross, Andrew S. ^{[1
]}

机构：

[1] Virginia Mason Med Ctr, Inst Digest Dis, Seattle, WA 98111 USA

来源：

GASTROINTESTINAL ENDOSCOPY | 2012年 / 75卷 / 04期

关键词：

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY; SINGLE-BALLOON; GALLSTONE FORMATION; ALTERED ANATOMY; SURGERY; OBESITY;

D O I：

10.1016/j.gie.2011.11.019

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

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. Objectives: To compare BEA-ERCP with LA-ERCP in post-RYGB patients and to identify factors that predict therapeutic success with BEA-ERCP. Design: Retrospective chart review. Setting: A single North American tertiary referral center. Patients: The review included 56 bariatric post-RYGB patients who underwent ERCP. Interventions: BEA-ERCP or LA-ERCP. Main Outcome Measurements: 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. Limitations: 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. (Gastrointest Endosc 2012;75:748-56.)

引用

页码：748 / 756

页数：9

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