Abstract
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.
Keywords
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Article info
Publication history
Published online: February 10, 2017
Accepted:
February 6,
2017
Received:
December 21,
2016
Identification
Copyright
© 2017 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
