Laparoscopic-Assisted ERCP in Patients with Roux-En-Y Anatomy

Terri A Zomerlei, BS, MPAS, Jennifer A McLellan, MD, Zyra C Cortez, BS, Scott J Cressman, BS, David E Scheeres, MD, FACS, James A Foote, MD, FACS

Michigan State University/Grand Rapids Medical Education Partners

INTRODUCTION: Performing endoscopic retrograde cholangiopancreatography (ERCP) on patients who have previously undergone Roux-en-Y gastric bypass (RNYGB) is logistically and technically challenging. Trials of perioral techniques using traditional side-viewing duodenoscopes and other longer forward-viewing colonoscopes and single or double balloon enteroscopes have been inconsistently successful and risky. Laparoscopic-assisted ERCP (LAERCP) may be used in these anatomically challenging patients as it allows access to the biliopancreatic duct via the gastric remnant. The objectives of this study are to provide a comprehensive description of the laparoscopic-assisted ERCP for standardization and to evaluate the success rate and immediate complications associated with this procedure on patients that have undergone this procedure at our institution.

METHODS: After obtaining IRB approval, charts were reviewed from 7 consecutive patients who underwent LAERCP between January 2007 and June 2012. Patient demographics collected included age,, BMI, length of time in months between RNYGB and LAERCP, and co-morbidities. Operative data collected included pre-operative diagnosis, operative findings, operative time and interventions required during the procedure. Post-operatively, the patient was evaluated for presence of pancreatitis, bleeding, leaks from the gastrotomy site, length of stay and readmission within 30 days.

In addition, the LAERCP technique utilized at our institution is described.

RESULTS: The mean age was 52 with a mean BMI of 31. All 7 patients underwent sphincterotomy and no patients required stents or drainage devices. The average length of stay was one day with no patients experiencing pancreatitis, leak from the gastrotomy site, bleeding or re-admission within 30 days.

CONCLUSIONS: Laparoscopic assisted ERCP is a safe, successful, and useful approach in the diagnosis and minimally invasive treatment of pancreaticobiliary conditions in patients with RNY anatomy.

Session: Poster Presentation

Program Number: P400

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