Division of Gastroenterology/Hepatology, Department of Medicine, Indiana University Medical Center, 550 N. University Boulevard, UH 4100, Indianapolis, IN 46202, USA.
Surg Endosc. 2013 Aug;27(8):2894-9. doi: 10.1007/s00464-013-2850-6. Epub 2013 Jun 21.
Roux-en-Y gastric bypass (RYGB) is the most common bariatric surgery. The performance of ERCP in bariatric RYGB is challenging due to the long Roux limb. We herein compared the indications and technical outcomes of ERCP via percutaneous gastrostomy (GERCP) and double balloon enteroscopy (DBERCP) for patients with prior bariatric RYGB anatomy.
Between December 2005 and November 2011, consecutive ERCP patients who had undergone RYGB were identified using a prospectively maintained electronic ERCP database. Medical records were abstracted for ERCP indications and outcomes. In most cases, the gastrostomy was done by either laparoscopic or open surgery and allowed to mature at least 1 month before performing ERCP. The choice of route for ERCP was at discretion of managing physician.
Forty-four patients (F = 42) with GERCP and 28 patients (F = 26) with DBERCP were identified. The mean age was younger in GERCP than DBERCP (44.8 vs. 56.1, p < 0.001). GERCP patients were more likely to have suspected sphincter of Oddi dysfunction (77 %) as the primary indication whereas DBERCP was suspected CBD stone (57 %). The mean total number of sessions/patient in GERCP and DBERCP was 1.7 ± 1.0 and 1.1 ± 0.4, respectively (p = 0.004). GERCP access to the major papilla was successful in all but two (97 %), whereas duct cannulation and interventions were successful in all. In DBERCP, the success rate of accessing major papilla, cannulation and therapeutic intervention was 78, 63, 56 %, respectively. There was one (3.1 %) post-ERCP pancreatitis in DBERCP. Complications occurred in 11 GERCP procedures (14.5 %) and 10 were related to the gastrostomy. This was significantly higher than that of DBERCP (p = 0.022).
GERCP is more effective than DBERCP in gaining access to the pancreatobiliary tree in patients with RYGB, but it is hindered by the gastrostomy maturation delay and a higher morbidity. Technical improvements in each method are needed.
Roux-en-Y 胃旁路术（RYGB）是最常见的减肥手术。由于 Roux 袢较长，对减肥 RYGB 患者进行 ERCP 操作具有挑战性。在此，我们比较了经皮胃造口术（GERCP）和双气囊小肠镜（DBERCP）用于既往减肥 RYGB 解剖患者的适应证和技术效果。
使用前瞻性维护的电子 ERCP 数据库，确定 2005 年 12 月至 2011 年 11 月间接受 RYGB 的连续 ERCP 患者。摘录病历以获取 ERCP 适应证和结果。在大多数情况下，胃造口术通过腹腔镜或开放性手术完成，并至少在进行 ERCP 前成熟 1 个月。ERCP 途径的选择由主治医生决定。
确定了 44 例接受 GERCP（F = 42）和 28 例接受 DBERCP（F = 26）的患者。GERCP 患者的平均年龄比 DBERCP 患者年轻（44.8 岁比 56.1 岁，p < 0.001）。GERCP 患者更可能因疑似Oddi 括约肌功能障碍（77%）作为主要适应证，而 DBERCP 患者则因疑似胆总管结石（57%）。GERCP 和 DBERCP 患者的平均就诊次数/患者分别为 1.7 ± 1.0 和 1.1 ± 0.4（p = 0.004）。GERCP 均能成功进入主要乳头，仅有两例（97%）除外，而胆管插管和介入均能成功。在 DBERCP 中，进入主要乳头、插管和治疗干预的成功率分别为 78%、63%和 56%。DBERCP 中有 1 例（3.1%）发生 ERCP 后胰腺炎。GERCP 中出现 11 例（14.5%）并发症，其中 10 例与胃造口术相关，显著高于 DBERCP（p = 0.022）。
在减肥 RYGB 患者中，GERCP 比 DBERCP 更有效地进入胰胆树，但因胃造口术成熟延迟和更高的发病率而受阻。需要改进每种方法的技术。
