David May, DO, David M Parker, MD, Ellen D Vogels, DO, Daaron McField, MD, Anthony T Petrick, MD, Jon Gabrielsen, MD. Geisinger Medical Center
Introduction: Biliary access following Roux-en-Y gastric bypass (RYGB) anatomy presents a significant challenge. Long term outcomes of Laparoscopic assisted trans-gastric ERCP (LAERCP) including Sphincter of Oddi Dysfunction (SOD) subtypes have not been examined. Our study aims to present our outcomes of trans-gastric LAERCP and examine a significant subgroup of patients with SOD after RYGB.
Methods & Procedures: A retrospective review of RYGB patients who underwent LAERCP between 2009 and 2016 identified 51 patients. A subgroup of 21 patients with SOD were examined and contacted by phone survey to determine long term symptom resolution.
Results: Post-procedure length of stay was 1.9 days (sd 3.0). Indications included choledocholithiasis (n=24), SOD (n=21) bile duct stricture (n=3), bile leak (n=1), recurrent pancreatitis (n=1), and diagnostic (n=1). There was one conversion from laparoscopic to open procedure. Selective cannulation rate was 100%. During a 14.6-month mean follow-up, there were 2 major operative complications (dislodged gastrostomy tube and transfusion) and 2 major ERCP related complications (repeat ERCP for hemobilia and a kinked stent). There were 5 (9.8%) wound infections. There were no deaths related to the intervention and no clinically significant pancreatitis. Within the SOD subgroup, 17 patients had biliary SOD (Type I=9, Type II=8). The remaining 4 had pancreatic SOD (Type I=1, Type II=3). SOD sub-group follow up was 21.4 months (SD 18.1). All patients with pancreatic SOD and Type I biliary SOD reported complete resolution of their symptoms.
Conclusions: Consistent with other published series, LAERCP appears to yield excellent cannulation rates after RYGB. The successful treatment of pancreatic and Type 1 biliary SOD suggests that there is significant benefit to treating this patient population with acceptable risks.
| n=21 | Symptom Resolution | ||
| Complete | No Change | ||
|
Biliary SOD |
17 (81%) |
12 (70.6%) | 5 (29.4%) |
| Type 1 | 9 (43%) | 9 (100%) |
0 |
| Type 2 | 8 (38%) | 3 (37.5%) | 5 (62.5%) |
| Pancreatic SOD | 4 (19%) | 4 (100%) | 0 |
| Type 1 | 1 (5%) | 1 (100%) | 0 |
| Type 2 | 3 (14%) | 3 (100%) | 0 |
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79200
Program Number: P089
Presentation Session: Poster (Non CME)
Presentation Type: Poster
