Paranandi Bharat, Joshi Deepak, Mohammadi Borzoueh, Jenkinson Andrew, Adamo Marco, Read Samantha, Johnson Gavin J, Chapman Michael H, Pereira Stephen P, Webster George J
Department of Pancreatobiliary Medicine, University College London Hospitals, London, UK.
Department of Bariatric Surgery, University College London Hospitals, London, UK.
Frontline Gastroenterol. 2016 Jan;7(1):54-59. doi: 10.1136/flgastro-2015-100556. Epub 2015 May 14.
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.
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.
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.
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.
减重胃旁路手术的实施越来越多，但由于无法经口进入胃部，此类患者的内镜逆行胰胆管造影术（ERCP）面临独特挑战。小规模研究表明，与经Roux-en-Y吻合口进行小肠镜检查相比，腹腔镜辅助ERCP（LA-ERCP）的技术成功率更高。我们介绍了本单位LA-ERCP的初步经验。
对2011年9月至2014年7月间在本单位接受LA-ERCP的连续患者进行回顾性病例系列研究。数据从电子、临床和内镜记录中获取。
共进行了7例LA-ERCP。所有7例患者均为女性，中位年龄44岁（范围36-71岁）。适应证包括有症状的胆管结石（5/7）、良性乳头纤维化（1/7）和留置胆管支架（1/7）。5/7（71%）的患者曾接受过胆囊切除术。为便于进行LA-ERCP，所有患者均创建了腹腔镜胃造口术端口。所有患者均成功实现十二指肠进入、胆管插管并完成治疗目标。6/7（86%）的患者需要进行内镜括约肌切开术。手术中位持续时间为94分钟（范围70-135分钟）。术后中位住院时间为2天（范围1-9天）。1例患者发生轻度术后急性胰腺炎，另1例患者发生轻度穿刺部位感染。除此之外，未发现与手术相关的并发症。所有患者随访情况良好（自ERCP日期起中位随访14个月（范围1-35个月）），无进一步胆道症状的证据。
我们LA-ERCP的早期经验表明，该方法安全有效。由于减重手术实施越来越多，对于胆管结石风险较高的患者群体，该技术可能需要特别考虑。
