Multicenter evaluation of the clinical utility of laparoscopy-assisted ERCP in patients with Roux-en-Y gastric bypass

LA-ERCP Research Group

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background and Aims: The obesity epidemic has led to increased use of Roux-en-Y gastric bypass (RYGB). These patients have an increased incidence of pancreaticobiliary diseases, yet standard ERCP is not possible because of surgically altered gastroduodenal anatomy. Laparoscopy-assisted ERCP (LA-ERCP) has been proposed as an option, but supporting data are derived from single-center small case series. Therefore, we conducted a large multicenter study to evaluate the feasibility, safety, and outcomes of LA-ERCP. Methods: This is a retrospective cohort study of adult patients with RYGB who underwent LA-ERCP in 34 centers. Data on demographics, indications, procedure success, and adverse events were collected. Procedure success was defined when all the following were achieved: reaching the papilla, cannulating the desired duct, and providing endoscopic therapy as clinically indicated. Results: A total of 579 patients (median age, 51; 84% women) were included. Indication for LA-ERCP was biliary in 89%, pancreatic in 8%, and both in 3%. Procedure success was achieved in 98%. Median total procedure time was 152 minutes (interquartile range [IQR], 109-210), with a median ERCP time of 40 minutes (IQR, 28-56). Median hospital stay was 2 days (IQR, 1-3). Adverse events were 18% (laparoscopy related, 10%; ERCP related, 7%; both, 1%) with the clear majority (92%) classified as mild/moderate, whereas 8% were severe and 1 death occurred. Conclusions: Our large multicenter study indicates that LA-ERCP in patients with RYGB is feasible with a high procedure success rate comparable with that of standard ERCP in patients with normal anatomy. The ERCP-related adverse events rate is comparable with conventional ERCP, but the overall adverse event rate was higher because of the added laparoscopy-related events.

Original languageEnglish (US)
Pages (from-to)1031-1039
Number of pages9
JournalGastrointestinal Endoscopy
Volume87
Issue number4
DOIs
StatePublished - Apr 1 2018

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Gastric Bypass
Endoscopic Retrograde Cholangiopancreatography
Laparoscopy
Multicenter Studies
Anatomy
Length of Stay
Cohort Studies
Retrospective Studies
Obesity
Demography
Safety

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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Multicenter evaluation of the clinical utility of laparoscopy-assisted ERCP in patients with Roux-en-Y gastric bypass. / LA-ERCP Research Group.

In: Gastrointestinal Endoscopy, Vol. 87, No. 4, 01.04.2018, p. 1031-1039.

Research output: Contribution to journalArticle

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title = "Multicenter evaluation of the clinical utility of laparoscopy-assisted ERCP in patients with Roux-en-Y gastric bypass",
abstract = "Background and Aims: The obesity epidemic has led to increased use of Roux-en-Y gastric bypass (RYGB). These patients have an increased incidence of pancreaticobiliary diseases, yet standard ERCP is not possible because of surgically altered gastroduodenal anatomy. Laparoscopy-assisted ERCP (LA-ERCP) has been proposed as an option, but supporting data are derived from single-center small case series. Therefore, we conducted a large multicenter study to evaluate the feasibility, safety, and outcomes of LA-ERCP. Methods: This is a retrospective cohort study of adult patients with RYGB who underwent LA-ERCP in 34 centers. Data on demographics, indications, procedure success, and adverse events were collected. Procedure success was defined when all the following were achieved: reaching the papilla, cannulating the desired duct, and providing endoscopic therapy as clinically indicated. Results: A total of 579 patients (median age, 51; 84{\%} women) were included. Indication for LA-ERCP was biliary in 89{\%}, pancreatic in 8{\%}, and both in 3{\%}. Procedure success was achieved in 98{\%}. Median total procedure time was 152 minutes (interquartile range [IQR], 109-210), with a median ERCP time of 40 minutes (IQR, 28-56). Median hospital stay was 2 days (IQR, 1-3). Adverse events were 18{\%} (laparoscopy related, 10{\%}; ERCP related, 7{\%}; both, 1{\%}) with the clear majority (92{\%}) classified as mild/moderate, whereas 8{\%} were severe and 1 death occurred. Conclusions: Our large multicenter study indicates that LA-ERCP in patients with RYGB is feasible with a high procedure success rate comparable with that of standard ERCP in patients with normal anatomy. The ERCP-related adverse events rate is comparable with conventional ERCP, but the overall adverse event rate was higher because of the added laparoscopy-related events.",
author = "{LA-ERCP Research Group} and Abbas, {Ali M.} and Strong, {Andrew T.} and Diehl, {David L.} and Brauer, {Brian C.} and Lee, {Iris H.} and Rebecca Burbridge and Jaroslav Zivny and Higa, {Jennifer T.} and Marcelo Falc{\~a}o and {El Hajj}, {Ihab I.} and Paul Tarnasky and Brintha Enestvedt and Ende, {Alexander R.} and Thaker, {Adarsh M.} and Rishi Pawa and Priya Jamidar and Kartik Sampath and {de Moura}, {Eduardo Guimar{\~a}es Hourneaux} and Kwon, {Richard S.} and Suarez, {Alejandro L.} and Murad Aburajab and Wang, {Andrew Y.} and Shakhatreh, {Mohammad H.} and Vivek Kaul and Lorna Kang and Kowalski, {Thomas E.} and Rahul Pannala and Jeffrey Tokar and Aadam, {A. Aziz} and Demetrios Tzimas and Wagh, {Mihir S.} and Draganov, {Peter V.} and Jeffrey Ponsky and Greenwald, {Bruce D.} and Uradomo, {Lance T.} and McGhan, {Alyson A.} and Shahrad Hakimian and Andrew Ross and Stuart Sherman and Bick, {Benjamin L.} and Forsmark, {Christopher E.} and Dennis Yang and Anand Gupte and Shailendra Chauhan and Hughes, {Steven J.} and Karen Saks and Gennadiy Bakis and Templeton, {Adam W.} and Michael Saunders and Alireza Sedarat",
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TY - JOUR

T1 - Multicenter evaluation of the clinical utility of laparoscopy-assisted ERCP in patients with Roux-en-Y gastric bypass

AU - LA-ERCP Research Group

AU - Abbas, Ali M.

AU - Strong, Andrew T.

AU - Diehl, David L.

AU - Brauer, Brian C.

AU - Lee, Iris H.

AU - Burbridge, Rebecca

AU - Zivny, Jaroslav

AU - Higa, Jennifer T.

AU - Falcão, Marcelo

AU - El Hajj, Ihab I.

AU - Tarnasky, Paul

AU - Enestvedt, Brintha

AU - Ende, Alexander R.

AU - Thaker, Adarsh M.

AU - Pawa, Rishi

AU - Jamidar, Priya

AU - Sampath, Kartik

AU - de Moura, Eduardo Guimarães Hourneaux

AU - Kwon, Richard S.

AU - Suarez, Alejandro L.

AU - Aburajab, Murad

AU - Wang, Andrew Y.

AU - Shakhatreh, Mohammad H.

AU - Kaul, Vivek

AU - Kang, Lorna

AU - Kowalski, Thomas E.

AU - Pannala, Rahul

AU - Tokar, Jeffrey

AU - Aadam, A. Aziz

AU - Tzimas, Demetrios

AU - Wagh, Mihir S.

AU - Draganov, Peter V.

AU - Ponsky, Jeffrey

AU - Greenwald, Bruce D.

AU - Uradomo, Lance T.

AU - McGhan, Alyson A.

AU - Hakimian, Shahrad

AU - Ross, Andrew

AU - Sherman, Stuart

AU - Bick, Benjamin L.

AU - Forsmark, Christopher E.

AU - Yang, Dennis

AU - Gupte, Anand

AU - Chauhan, Shailendra

AU - Hughes, Steven J.

AU - Saks, Karen

AU - Bakis, Gennadiy

AU - Templeton, Adam W.

AU - Saunders, Michael

AU - Sedarat, Alireza

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Background and Aims: The obesity epidemic has led to increased use of Roux-en-Y gastric bypass (RYGB). These patients have an increased incidence of pancreaticobiliary diseases, yet standard ERCP is not possible because of surgically altered gastroduodenal anatomy. Laparoscopy-assisted ERCP (LA-ERCP) has been proposed as an option, but supporting data are derived from single-center small case series. Therefore, we conducted a large multicenter study to evaluate the feasibility, safety, and outcomes of LA-ERCP. Methods: This is a retrospective cohort study of adult patients with RYGB who underwent LA-ERCP in 34 centers. Data on demographics, indications, procedure success, and adverse events were collected. Procedure success was defined when all the following were achieved: reaching the papilla, cannulating the desired duct, and providing endoscopic therapy as clinically indicated. Results: A total of 579 patients (median age, 51; 84% women) were included. Indication for LA-ERCP was biliary in 89%, pancreatic in 8%, and both in 3%. Procedure success was achieved in 98%. Median total procedure time was 152 minutes (interquartile range [IQR], 109-210), with a median ERCP time of 40 minutes (IQR, 28-56). Median hospital stay was 2 days (IQR, 1-3). Adverse events were 18% (laparoscopy related, 10%; ERCP related, 7%; both, 1%) with the clear majority (92%) classified as mild/moderate, whereas 8% were severe and 1 death occurred. Conclusions: Our large multicenter study indicates that LA-ERCP in patients with RYGB is feasible with a high procedure success rate comparable with that of standard ERCP in patients with normal anatomy. The ERCP-related adverse events rate is comparable with conventional ERCP, but the overall adverse event rate was higher because of the added laparoscopy-related events.

AB - Background and Aims: The obesity epidemic has led to increased use of Roux-en-Y gastric bypass (RYGB). These patients have an increased incidence of pancreaticobiliary diseases, yet standard ERCP is not possible because of surgically altered gastroduodenal anatomy. Laparoscopy-assisted ERCP (LA-ERCP) has been proposed as an option, but supporting data are derived from single-center small case series. Therefore, we conducted a large multicenter study to evaluate the feasibility, safety, and outcomes of LA-ERCP. Methods: This is a retrospective cohort study of adult patients with RYGB who underwent LA-ERCP in 34 centers. Data on demographics, indications, procedure success, and adverse events were collected. Procedure success was defined when all the following were achieved: reaching the papilla, cannulating the desired duct, and providing endoscopic therapy as clinically indicated. Results: A total of 579 patients (median age, 51; 84% women) were included. Indication for LA-ERCP was biliary in 89%, pancreatic in 8%, and both in 3%. Procedure success was achieved in 98%. Median total procedure time was 152 minutes (interquartile range [IQR], 109-210), with a median ERCP time of 40 minutes (IQR, 28-56). Median hospital stay was 2 days (IQR, 1-3). Adverse events were 18% (laparoscopy related, 10%; ERCP related, 7%; both, 1%) with the clear majority (92%) classified as mild/moderate, whereas 8% were severe and 1 death occurred. Conclusions: Our large multicenter study indicates that LA-ERCP in patients with RYGB is feasible with a high procedure success rate comparable with that of standard ERCP in patients with normal anatomy. The ERCP-related adverse events rate is comparable with conventional ERCP, but the overall adverse event rate was higher because of the added laparoscopy-related events.

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U2 - 10.1016/j.gie.2017.10.044

DO - 10.1016/j.gie.2017.10.044

M3 - Article

VL - 87

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EP - 1039

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

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