Systematic review of transgastric ERCP in Roux-en-Y gastric bypass patients.
Balloon-assisted endoscopic retrograde cholangiopancreatoscopy (ERCP) in Roux-en-Y gastric bypass (RYGB) patients is technically challenging due to anatomic and accessory constraints, thus success rates are modest. Transgastric ERCP (TG-ERCP) offers a viable alternative. We aimed to systematically review the literature on TG-ERCP in RYGB patients to better define the technical approaches, success rates, and adverse events of this procedure. A computer-assisted search of the Embase and PubMed databases was performed to identify studies that focused on the techniques and clinical outcomes of TG-ERCP. Two investigators independently identified studies and abstracted relevant data. The literature search yielded 26 eligible studies comprising 509 TG-ERCP cases. Access to the excluded stomach to facilitate ERCP was achieved laparoscopically in 58% of reported cases, via open surgery (6% of reported cases), by antecedent placement of a percutaneous gastrostomy tube (33%), or with endoscopic ultrasound assistance (3%). Successful gastric access was reported in 100% of cases and successful ductal cannulation in 98.5%. Adverse events were reported in 14% of cases; 80% of these were related to gastrostomy creation and the rest were attributable to ERCP. Wound infections (n = 19, 3.7%) were the most common gastrostomy-related adverse event, and post-ERCP pancreatitis (n = 7, 1.4%) was the most common ERCP-related adverse event. No deaths were reported. Based on existing observational studies, TG-ERCP appears to be a safe and highly effective approach in patients with RYGB anatomy. Additional research and clinical experience are needed to more precisely define the risk-benefit ratio and optimal technique of TG-ERCP.
['Banerjee|Nikhil|N|', 'Parepally|Mayur|M|', 'Byrne|T Karl|TK|', 'Pullatt|Rana C|RC|', 'Coté|Gregory A|GA|', 'Elmunzer|B Joseph|BJ|']
D001660:Biliary Tract Diseases D002760:Cholangiopancreatography, Endoscopic Retrograde D015905:Gastric Balloon D015390:Gastric Bypass D005774:Gastrostomy D006801:Humans D010535:Laparoscopy D011183:Postoperative Complications D016896:Treatment Outcome
ERCP Bariatric surgery Roux-en-Y gastric bypass surgery