Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of Sao Paulo School of Medicine, Avenida Dr. Enéas de Carvalho Aguiar, 155, 6 andar, São Paulo, SP CEP 05403-900, Brazil.
, São Paulo, Brazil.
Obes Surg. 2018 Dec;28(12):4064-4076. doi: 10.1007/s11695-018-3507-2.
Although balloon-assisted enteroscopy-endoscopic retrograde cholangiopancreatography (BAE-ERCP) is a well-described means of accessing the duodenal papilla in patients with Roux-en-Y gastric bypass (RYGB), it is associated with modest clinical success rates. Laparoscopy-assisted ERCP (LA-ERCP)-performed by advancing a standard duodenoscope through a gastrostomy into the excluded stomach and duodenum-has emerged as a viable alternative to BAE-ERCP, with apparently higher success rates. In this systematic review, we compare LA-ERCP with enteroscopy-based techniques in post-RYGB patients, including 22 case series that provided data on papilla identification, papilla cannulation, and complications. We found that LA-ERCP was superior to the enteroscopy-based techniques in its capacity to reach the duodenal papilla, although complication rates were lower for the latter. Comparative studies are needed in order to corroborate our findings.
虽然球囊辅助式小肠镜-内镜逆行胰胆管造影术（BAE-ERCP）是一种在 Roux-en-Y 胃旁路术（RYGB）患者中进入十二指肠乳头的成熟方法，但它的临床成功率并不高。通过将标准的十二指肠镜经胃造口进入已被排除在外的胃和十二指肠来进行的腹腔镜辅助 ERCP（LA-ERCP），已成为 BAE-ERCP 的可行替代方法，其成功率明显更高。在这项系统评价中，我们比较了 LA-ERCP 与基于小肠镜的技术在 RYGB 术后患者中的应用，其中 22 项病例系列研究提供了有关乳头识别、乳头插管和并发症的数据。我们发现，LA-ERCP 在到达十二指肠乳头方面优于基于小肠镜的技术，尽管后者的并发症发生率较低。需要进行对比研究来证实我们的发现。
