Clinical Effectiveness Research Group, Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
Section of Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.
Endoscopy. 2020 Aug;52(8):654-661. doi: 10.1055/a-1139-9313. Epub 2020 Apr 21.
Patients who have undergone Roux-en-Y gastric bypass (RYGB) are at increased risk of biliary disease necessitating endoscopic retrograde cholangiopancreatography (ERCP). The most widely used approaches to perform ERCP after RYGB are laparoscopy-assisted ERCP (LA-ERCP) and balloon enteroscopy-assisted ERCP (BEA-ERCP). There are few studies comparing these procedures. We aimed to compare the performance, benefits, and harms of LA-ERCP and BEA-ERCP in RYGB patients.
We identified all RYGB patients who underwent ERCP at two tertiary care endoscopy centers in Oslo, Norway between May 2013 and December 2017. One center performed BEA-ERCP, the other LA-ERCP. Procedure success was defined as fulfillment of the therapeutic or diagnostic aim, according to the procedure description. Adverse events were classified according to the Clavien-Dindo grading system.
During the study period, 40 BEA-ERCP and 39 LA-ERCP procedures were performed in 68 patients. Procedure success rate was 72.5 % for BEA-ERCP and 87.2 % for LA-ERCP ( = 0.14). Adverse events occurred in 18 % of BEA-ERCP and 28 % of LA-ERCP ( = 0.23). Serious adverse events (Clavien-Dindo grade ≥ 3b) occurred in 2.5 % of BEA-ERCP and 7.7 % of LA-ERCP procedures ( = 0.36). Concomitant cholecystectomy was performed in 25 of the 39 LA-ERCP procedures. The median procedure times for LA-ERCP performed with and without concomitant cholecystectomy were 201 minutes and 140 minutes, respectively, and for BEA-ERCP was 125 minutes.
In experienced hands, both LA-ERCP and BEA-ERCP have high success rates after RYGB. The choice of approach should be individualized according to patient characteristics and available physician competence.
接受 Roux-en-Y 胃旁路术（RYGB）的患者发生胆病的风险增加，需要进行内镜逆行胰胆管造影术（ERCP）。在 RYGB 后进行 ERCP 最常用的方法是腹腔镜辅助 ERCP（LA-ERCP）和气囊小肠镜辅助 ERCP（BEA-ERCP）。比较这些方法的研究很少。我们旨在比较 LA-ERCP 和 BEA-ERCP 在 RYGB 患者中的表现、益处和危害。
我们在挪威奥斯陆的两个三级护理内镜中心确定了所有在 2013 年 5 月至 2017 年 12 月期间接受 ERCP 的 RYGB 患者。一个中心进行 BEA-ERCP，另一个中心进行 LA-ERCP。根据手术描述，将手术成功率定义为满足治疗或诊断目的。不良事件根据 Clavien-Dindo 分级系统进行分类。
在研究期间，对 68 名患者进行了 40 例 BEA-ERCP 和 39 例 LA-ERCP。BEA-ERCP 的手术成功率为 72.5%，LA-ERCP 为 87.2%（ = 0.14）。BEA-ERCP 发生不良事件的比例为 18%，LA-ERCP 为 28%（ = 0.23）。严重不良事件（Clavien-Dindo 分级 ≥ 3b）在 BEA-ERCP 和 LA-ERCP 中分别发生在 2.5%和 7.7%的患者中（ = 0.36）。39 例 LA-ERCP 中有 25 例同时进行了胆囊切除术。LA-ERCP 行与不行胆囊切除术的中位手术时间分别为 201 分钟和 140 分钟，BEA-ERCP 为 125 分钟。
在有经验的医生手中，LA-ERCP 和 BEA-ERCP 在 RYGB 后均有很高的成功率。方法的选择应根据患者的特点和医生的能力来个体化。
