David May, MD, David M Parker, MD, Ellen D Vogels, DO, Daaron McField, MD, James Dove, Marcus Fluck, Anthony T Petrick, MD, Jon Gabrielsen, MD. Geisinger Medical Center
Introduction: Roux-en-Y gastric bypass (RYGB) anatomy presents a challenge should access to the biliary tree be required. In 2014 Grimes reported a series of 42 LAERCP patients, 36 of which were for suspected Sphincter of Oddi dysfunction (SOD). However, outcomes of this treatment for SOD with attention to SOD type and long term outcomes in the RYGB population 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: Retrospective review of RYGB patients who underwent LAERCP between 5/2009 and 8/2016. Fifty-one patients were identified and records reviewed for preoperative characteristics, perioperative and long term outcomes. A subgroup of 21 patients with SOD was examined and contacted by phone survey to determine long term symptom resolution.
Results: Fifty-one patients underwent LAERCPs. 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 complications. One patient required reoperation for a dislodged gastrostomy tube and one required blood transfusion. Two patients required repeat ERCP for hemobilia and a kinked bile duct stent. There were 5 (9.8%) wound infections, 1 of these required radiologic drainage. There were no deaths related to the intervention and no clinically significant episodes of 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, whereas only 5/8 (37.5%) of patients with Type II biliary SOD reported resolution of symptoms.
Conclusions: Consistent with other published series, LAERCP appears to yield excellent cannulation rate after RYGB. The successful treatment rate for biliary Type 1 SOD and pancreatic Type 1 and 2 SOD suggests that there is significant benefit to treating this patient population with an acceptable risk profile.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80478
Program Number: P094
Presentation Session: Poster (Non CME)
Presentation Type: Poster