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
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