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Temporary Trans-gastric Stent Deployment Over a 20 French Gastrostomy for Single-Stage Endoscopic Retrograde Cholangiopancreatography After Gastric Bypass

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Abstract

Introduction

Treatment of pancreato-biliary disorders after gastric bypass is challenging due to altered anatomy. Several techniques have been proposed to overcome this condition; however, none has emerged as the gold standard treatment. Furthermore, a decision-making algorithm evaluating when and why apply one technique over another is still lacking.

Objectives

To describe a novel trans-gastric approach to allow endoscopic retrograde cholangiopancreatography (ERCP) in Roux-en-Y gastric bypass (RYGB) anatomy soon after prior laparoscopic cholecystectomy (LC) and to propose a decision-making algorithm for selection of the most suitable technique according a tailored approach.

Setting

Private hospital.

Methods

Between January and March 2020, patients with Roux-en-Y gastric bypass anatomy referred to our tertiary center to undergo ERCP after recent laparoscopic cholecystectomy were retrospectively evaluated. A 20 french (Fr) gastrostomy was performed during cholecystectomy. A single-stage ERCP was carried out by means of temporary trans-gastric stent deployment over a 20 Fr gastrostomy.

Results

A total of 5 patients (mean age 41; mean body mass index 48.3) were enrolled. ERCP was performed after an average of 2 days from surgery. Technical and clinical success was achieved in 100%. No adverse events occurred. Spontaneous closure of the gastrostomy after its bedside removal was observed in all cases.

Conclusions

Our approach allows to perform a single-stage ERCP in RYGB patients, early after LC, with no need of any other re-interventions. Any surgeon facing unexpected biliary disorders, during LC, can easily perform a 20 Fr gastrostomy thus allowing the patient to undergo early ERCP without any delay.

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References

  1. Angrisani L, Santonicola A, Iovino P, et al. IFSO worldwide survey 2016: primary, endoluminal, and revisional procedures. Obes Surg. 2018;28:3783–94.

    Article  Google Scholar 

  2. Shiffman ML, Sugerman HJ, Kellum JM, et al. Gallstone formation after rapid weight loss: a prospective study in patients undergoing gastric bypass surgery for treatment of morbid obesity. Am J Gastroenterol. 1991;86:1000–5.

    CAS  PubMed  Google Scholar 

  3. Nagem RG, Lazaro-da-Silva A, de Oliveira RM, et al. Gallstone-related complications after Roux-en-Y gastric bypass: a prospective study. Hepatobiliary Pancreat Dis Int. 2012;11:630–5.

    Article  Google Scholar 

  4. Calle EE, Rodriguez C, Walker-Thurmond K, et al. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med. 2003;348:1625–38.

    Article  Google Scholar 

  5. Singh AN, Kilambi R. Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with gallbladder stones with common bile duct stones: systematic review and meta-analysis of randomized trials with trial sequential analysis. Surg Endosc. 2018;32(9):3763–76. https://doi.org/10.1007/s00464-018-6170-8.

    Article  PubMed  Google Scholar 

  6. Helton WS, Ayloo S. Technical aspects of bile duct evaluation and exploration: an update. Surg Clin North Am. 2019;99(2):259–82. https://doi.org/10.1016/j.suc.2018.12.007.

    Article  PubMed  Google Scholar 

  7. Milella M, Alfa-Wali M, Leuratti L, et al. Percutaneous transhepatic cholangiography for choledocholithiasis after laparoscopic gastric bypass surgery. Int J Surg Case Rep. 2014;5(5):249–52. https://doi.org/10.1016/j.ijscr.2014.03.003.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Weinberg BM, Shindy W, Lo S. Endoscopic balloon sphincter dilation (sphincteroplasty) versus sphincterotomy for common bile duct stones. Cochrane Database Syst Rev. 2006;4:CD004890.

    Google Scholar 

  9. Emmett DS, Mallat DB. Double-balloon ERCP in patients who have undergone Roux-en-Y surgery: a case series. Gastrointest Endosc. 2007;66(5):1038–41. https://doi.org/10.1016/j.gie.2007.06.056.

    Article  PubMed  Google Scholar 

  10. Bowman E, Greenberg J, Garren M, et al. Laparoscopic-assisted ERCP and EUS in patients with prior Roux-en-Y gastric bypass surgery: a dual-center case series experience. Surg Endosc. 2016;30(10):4647–52. https://doi.org/10.1007/s00464-016-4746-8.

    Article  PubMed  Google Scholar 

  11. Ngamruengphong S, Nieto J, Kunda R, et al. Endoscopic ultrasound-guided creation of a transgastric fistula for the management of hepatobiliary disease in patients with Roux-en-Y gastric bypass. Endoscopy. 2017;49(6):549–52. https://doi.org/10.1055/s-0043-105072.

    Article  PubMed  Google Scholar 

  12. Bankhead RR, Fisher CA, Rolandelli RH. Gastrostomy tube placement outcomes: comparison of surgical, endoscopic, and laparoscopic methods. Nutr Clin Pract. 2005;20:607–12.

    Article  Google Scholar 

  13. Tønnesen CJ, Young J, Glomsaker T, et al. Laparoscopy-assisted versus balloon enteroscopy-assisted ERCP after Roux-en-Y gastric bypass. Endoscopy. 2020; https://doi.org/10.1055/a-1139-9313.

  14. Dorman RB, Zhong W, Abraham AA, et al. Does concomitant cholecystectomy at time of Roux-en-Y gastric bypass impact adverse operative outcomes? Obes Surg. 2013;23(11):1718–26.

    Article  Google Scholar 

  15. Warschkow R, Tarantino I, Ukegjini K, et al. Concomitant chole-cystectomy during laparoscopic Roux-en-Y gastric bypass in obese patients is not justified: a meta-analysis. Obes Surg. 2013;23:397–407.

    Article  Google Scholar 

  16. Altieri MS, Yang J, Nie L, et al. Incidence of cholecystectomy after bariatric surgery. Surg Obes Relat Dis. 2018;14(7):992–6.

    Article  Google Scholar 

  17. Weiss AC, Inui T, Parina R, et al. Concomitant cholecystectomy should be routinely performed with laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2015;29(11):3106–11. https://doi.org/10.1007/s00464-014-4033-5.

    Article  PubMed  Google Scholar 

  18. Sneineh MA, Harel L, Elnasasra A, et al. Increased incidence of symptomatic cholelithiasis after bariatric Roux-en-Y gastric bypass and previous bariatric surgery: a single center experience. Obes Surg. 2020;30(3):846–50. https://doi.org/10.1007/s11695-019-04366-6.

    Article  PubMed  Google Scholar 

  19. Arapis K, Donatelli G, Tammaro P, et al. Janeway gastrostomy for trans-gastric ERCP: an emergency alternative method to access the excluded structures. Obes Surg. 2018;28(9):2916–7. https://doi.org/10.1007/s11695-018-3349-.

    Article  PubMed  Google Scholar 

  20. Weilert F, Binmoeller KF, Marson F, et al. Endoscopic ultrasound-guided anterograde treatment of biliary stones following gastric bypass. Endoscopy. 2011;43(12):1105–8. https://doi.org/10.1055/s-0030-1256961.

    Article  CAS  PubMed  Google Scholar 

  21. Ahmed AR, Husain S, Saad N, et al. Accessing the common bile duct after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2007;3(6):640–3. https://doi.org/10.1016/j.soard.2007.06.004.

    Article  PubMed  Google Scholar 

  22. Bukhari M, Kowalski T, Nieto J, et al. An international, multicenter, comparative trial of EUS-guided gastrogastrostomy-assisted ERCP versus enteroscopy-assisted ERCP in patients with Roux-en-Y gastric bypass anatomy. Gastrointest Endosc. 2018;88(3):486–94. https://doi.org/10.1016/j.gie.2018.04.2356.

    Article  PubMed  Google Scholar 

  23. Tyberg A, Nieto J, Salgado S, et al. Endoscopic ultrasound (EUS)- directed transgastric endoscopic retrograde cholangiopancreatography or EUS: mid-term analysis of an emerging procedure. Clin Endosc. 2017;50:185–90.

    Article  Google Scholar 

  24. James HJ, James TW, Wheeler B, et al. Cost-effectiveness of endoscopic ultrasound-directed transgastric ERCP compared with device-assisted and laparoscopic-assisted ERCP in patients with Roux-en-Y anatomy. Endoscopy. 2019;51:1051–8.

    Article  Google Scholar 

  25. Morgan DJ, Ho KM. A comparison of bariatric surgery in hospitals with and without ICU: a linked data cohort study. Obes Surg. 2016;26:313–20.

    Article  Google Scholar 

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Authors and Affiliations

  1. Unité d’Endoscopie Interventionnelle, Hôpital Privé des Peupliers, Ramsay Santé, 8 Place de l’Abbé G. Hénocque, 75013, Paris, France

    Gianfranco Donatelli, Fabrizio Cereatti, Andrea Spota, Thierry Tuszynski, David Danan & Jean-Loup Dumont

  2. Gastroenterologia ed Endoscopia Digestiva ASST Cremona, Cremona, Italy

    Fabrizio Cereatti

  3. Scuola di Specializzazione in Chirurgia Generale, Università degli studi di Milano, Milan, Italy

    Andrea Spota

Authors
  1. Gianfranco Donatelli
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  2. Fabrizio Cereatti
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  3. Andrea Spota
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  4. Thierry Tuszynski
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  5. David Danan
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  6. Jean-Loup Dumont
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Contributions

Gianfranco Donatelli: performed endoscopic procedure, managed patients, analyzed data, wrote the paper and performed critical revision of the manuscript for important intellectual contents, and made the final manuscript.

Fabrizio Cereatti, Andre Spota: analyzed data, wrote the paper, and performed critical revision of the manuscript.

Thierry Tuszynsky, David Danan, Jean-Loup Dumont: managed patients and performed critical revision of the manuscript.

Corresponding author

Correspondence to Gianfranco Donatelli.

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The authors declare that they have no conflict of interest.

Human and Animal Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Donatelli, G., Cereatti, F., Spota, A. et al. Temporary Trans-gastric Stent Deployment Over a 20 French Gastrostomy for Single-Stage Endoscopic Retrograde Cholangiopancreatography After Gastric Bypass. OBES SURG 30, 4130–4137 (2020). https://doi.org/10.1007/s11695-020-04857-x

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  • DOI: https://doi.org/10.1007/s11695-020-04857-x

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