Tailored access to the hepatobiliary system in post-bariatric patients: a tertiary care bariatric center experience.

Kröll, Dino; Müller, Alexandra Charlotte; Nett, Philipp C.; Wiest, Reiner; Maubach, Johannes Andreas; Stirnimann, Guido; Candinas, Daniel; Borbély, Yves Michael (2020). Tailored access to the hepatobiliary system in post-bariatric patients: a tertiary care bariatric center experience. Surgical endoscopy, 34(12), pp. 5469-5476. Springer-Verlag 10.1007/s00464-019-07343-3

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BACKGROUND

In bariatric surgery patients, pancreaticobiliary access via endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging and the optimal approach for the evaluation and treatment of biliary tree-related pathologies has been debated. Besides laparoscopy-assisted ERCP (LA-ERCP) as standard of care, EUS-directed transgastric ERCP (EDGE) and hepaticogastrostomy (HGS) with placement of a fully covered metal stent have emerged as novel techniques. The objective of this study was to evaluate safety and efficacy of three different endoscopic approaches (LA-ERCP, EDGE, and HGS) in bariatric patients.

METHODS

In this retrospective review, consecutive patients with Roux-en-Y gastric bypass (RYGB) and Sleeve Gastrectomy (SG) who underwent from 2013 to 2019 a LA-ERCP, an EDGE, or a HGS at a tertiary care reference center for bariatric surgery were analyzed. Patient demographics, type of procedure and indication, data regarding cannulation and therapeutic intervention of the common bile duct (procedure success), and clinical outcomes were analyzed.

RESULTS

A total of 19 patients were included. Indications for LA-ERCP, EDGE, or HGS were mostly choledocholithiasis (78.9%) and in a few cases papillitis stenosans. Eight patients (57.1%) with LA-ERCP underwent concomitant cholecystectomy. Procedure success was achieved in 100%. Adverse events (AEs) were identified in 15.7% of patients (all ERCP related). All AEs were rated as moderate and there were no serious AEs.

CONCLUSION

This case series indicates that ERCP via a transgastric approach (LA-ERCP, EDGE, or HGS) is a minimally invasive, effective, and feasible method to access the biliary tree in bariatric patients. These techniques offer an appealing alternative treatment option compared to percutaneous transhepatic cholangiography and drainage- or deep enteroscopy-assisted ERCP. In bariatric patients who earlier had a cholecystectomy, EUS-guided techniques were the preferred treatment options for biliary pathologies.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Gastroenterology
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Hepatology
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Visceral Surgery
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine

UniBE Contributor:

Kröll, Dino; Müller, Alexandra Charlotte; Nett, Philipp C.; Wiest, Reiner; Maubach, Johannes Andreas; Stirnimann, Guido; Candinas, Daniel and Borbély, Yves Michael

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0930-2794

Publisher:

Springer-Verlag

Language:

English

Submitter:

Rahel Fuhrer

Date Deposited:

16 Dec 2020 11:15

Last Modified:

16 Dec 2020 11:15

Publisher DOI:

10.1007/s00464-019-07343-3

PubMed ID:

31993808

Uncontrolled Keywords:

Bariatric surgery EDGE Endoscopic retrograde cholangiopancreaticography HGS Laparoscopically assisted Roux-en-Y gastric bypass

BORIS DOI:

10.7892/boris.148420

URI:

https://boris.unibe.ch/id/eprint/148420

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