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You are here: Home / Abstracts / Single institution experience with minimally invasive trans gastric-remnant ERCP in patients with previous gastric bypass.

Single institution experience with minimally invasive trans gastric-remnant ERCP in patients with previous gastric bypass.

Michael J Passeri, MD, William B Lyman, MD, Andrew Dries, Tarun Narang, Stephen Deal, Jason Lewis, Shailendra Chauhan, John Martinie, Dionisios Vrochides, Erin Baker, David Iannitti. Carolinas Medical Center

Background: The obesity epidemic in the United States has been accompanied by surge in bariatric surgery.  Nearly 200,000 bariatric procedures were performed in the US in 2015, 23% of which involved Roux-en-Y gastric bypass (RNYGB).  While RNYGB has proven an effective tool in combating obesity, it also alters a patient’s anatomy in a way that makes traditional ERCP a difficult, if not impossible option for interrogating the common bile duct.  One way to approach the post-RNYGB patient with obstructive jaundice is to access the peritoneal cavity via a laparoscopic/robotic approach followed by direct cannulation of the gastric remnant with a laparoscopic port, allowing passage of an endoscope.  The aim of this study was to evaluate our single center experience with minimally-invasive transgastric ERCP (TG-ERCP) from 2010 to 2017.

Methods: We compiled a list of all patients who underwent laparoscopically or robotically assisted TG-ERCP at our institution from 2010-2017.  We then examined patient demographics, procedural details, postoperative outcomes, and success rate, with success defined as cannulation of the ampulla, clearance of obstruction if present (stones/sludge/stenotic ampulla), and completion imaging of the biliary and pancreatic ducts.

Results: 40 patients were included in the study.  2 cases were performed robotically (5%), and 38 laparoscopically (95%).  ERCP was successful in 36 cases (90%).  All 4 unsuccessful attempts were aborted when the endoscopist was unable to pass the scope through a tight pylorus.  Median time of operation was 163 minutes (199 minutes if concomitant cholecystectomy was performed, 159 minutes if not).  Median length of stay after operation was 2 days (range 1-14 days).  Median estimated blood loss (EBL) was 50mL.  Post ERCP pancreatitis occurred in 3 patients (8.3%), and was mild and self limited in all cases.  2 patients had postoperative bleeding requiring transfusion.  Both of these had concomitant cholecystectomy.

Discussion: In patients with biliary obstruction and anatomy not suitable for traditional ERCP, TG-ERCP is a viable option.  It can be performed with in a minimally invasive fashion (either laparoscopically or robotically) with a high success rate and low morbidity.  As the population of patients who have undergone RNYGB continues to grow, so does the likelihood of encountering one with obstructive jaundice.  TG-ERCP, therefore, should be thought of as an essential tool in the armamentarium of the general surgeon.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 87133

Program Number: P668

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

41

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