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Research
Laparoscopy-assisted ERCP (LA-ERCP) following bariatric gastric bypass surgery: initial experience of a single UK centre
  1. Bharat Paranandi1,
  2. Deepak Joshi1,
  3. Borzoueh Mohammadi2,
  4. Andrew Jenkinson2,
  5. Marco Adamo2,
  6. Samantha Read3,
  7. Gavin J Johnson1,
  8. Michael H Chapman1,
  9. Stephen P Pereira1,
  10. George J Webster1
  1. 1Department of Pancreatobiliary Medicine, University College London Hospitals, London, UK
  2. 2Department of Bariatric Surgery, University College London Hospitals, London, UK
  3. 3Department of Radiology, University College London Hospitals, London, UK
  1. Correspondence to Dr George J Webster, Department of Gastroenterology, University College London Hospitals, 250 Euston Road, London NW1 2PG, UK; george.webster{at}uclh.nhs.uk

Abstract

Background Bariatric gastric bypass surgery is being increasingly performed, but endoscopic retrograde cholangiopancreatography (ERCP) in these patients poses a unique challenge because of a lack of per-oral access to the stomach. Small series suggest a higher technical success rate using laparoscopy-assisted ERCP (LA-ERCP) than with an enteroscopic approach via the Roux-en-Y anastomosis. We present initial experience of LA-ERCP in our unit.

Design Retrospective case series of consecutive patients undergoing LA-ERCP in our unit between September 2011 and July 2014. Data was retrieved from electronic, clinical and endoscopy records.

Results Seven LA-ERCPs were performed. All seven patients were female, with median age 44 years (range 36–71). Indications included symptomatic bile duct stones (5/7), benign papillary fibrosis (1/7) and retained biliary stent (1/7). 5/7 (71%) patients had had a prior cholecystectomy. To facilitate LA-ERCP, laparoscopic gastrostomy ports were created in all patients. Duodenal access, biliary cannulation and completion of therapeutic aim were achieved in all patients. 6/7 (86%) patients required endoscopic sphincterotomy. The median duration of procedures was 94 min (range 70–135). Median postoperative length of stay was 2 days (range 1–9). One patient developed mild postprocedural acute pancreatitis, and another patient developed a mild port-site infection. Otherwise, no procedure-related complications were seen. All patients remained well on follow-up (median 14 months (range 1–35) from date of ERCP), with no evidence of further biliary symptoms.

Conclusions Our early experience of LA-ERCP is that it is safe and effective. The technique may require particular consideration, as bariatric surgery is increasingly performed, in a patient group at significant risk of bile duct stones.

  • ENDOSCOPIC RETROGRADE PANCREATOGRAPHY
  • GALLSTONES
  • BILE DUCT STONES
  • GASTRECTOMY
  • BILIARY ENDOSCOPY

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