Mo1438 Accessing the Papilla for ERCP in Bariatric Roux-en-Y Gastric Bypass (RNYGB): Can Clinical Features Predict Success of PerOral Endoscopy?

Autor: Roy Cobean, Gennadiy Bakis, Jennifer Lewis, David Y. Lo, Eric Wright, Andreas M. Stefan, Lee D. Hallagan, Douglas A. Howell
Rok vydání: 2011
Předmět:
Zdroj: Gastrointestinal Endoscopy. 73:AB346
ISSN: 0016-5107
Popis: Accessing the Papilla for ERCP in Bariatric Roux-en-Y Gastric Bypass (RNYGB): Can Clinical Features Predict Success of PerOral Endoscopy? David Y. Lo, Douglas A. Howell, Lee D. Hallagan, Jennifer Lewis, Eric Wright, Gennadiy Bakis, Andreas M. Stefan, Roy A. Cobean Pancreaticobilary Center, Maine Medical Center, Portland, ME; Surgery, Maine Medical Center, Portland, ME Background: RNYGB has been increasingly performed worldwide resulting in growing numbers of patients needing ERCP. Accessing the papilla for ERCP includes peroral enteroscopic techniques and laparoscopic access to the bypassed stomach to allow antegrade passage of a standard ERCP endoscope via a 15mm port. Study Aim: Attempt to define clinical features which might predict success or failure of peroral access to the papilla. Methods: All bariatric RNYGB patients undergoing peroral attempt at ERCP entered in a prospective ERCP database from a single center were identified after IRB approval. Pre-procedure clinical features suspected to have an impact on success were: 1. Recorded length of Roux limb. 2. Pre-op BMI. 3. Absolute weight loss. 4. Percent of weight loss. 5. BMI at the time of ERCP. 6. Open vs laparoscopic RNYGB. Patients: 43 pts identified underwent 55 peroral attempts at RNYGB ERCP (M:5; F:38), age 24 to 81) and had complete or partial data available for analysis of these defined variables. Patients were divided into 2 groups: Group A (n 23), cases done using single balloon enteroscopes (Olympus America) or rotational overtubes (Spirus Medical) and Group B (n 20), earlier cases using a variety of endoscopes. Results: Of 43 cases, the papilla could be reached in 30 cases (69.8%). Success in reaching the RUQ was more frequent when open surgery had been done (74.2% vs 50%) despite some failures due to obvious adhesions detected during the ERCP. Comparing Group A to Group B, there was a trend toward increased success of RUQ access, despite longer Roux limbs done more recently (A 18/23 (78.3%) vs B 12/20 (60%), p 0.074). Once the RUQ was reached, none of the pre-procedure clinical features impacted the success of the planned ERCP (25/30, (83.3%)). Among Group A pts, 3 features were strongly associated with success or failure to reach the RUQ on univariate analysis (see Table). The categorical variable which best predicted failure was the recorded length of the Roux limb 150cm, as 60% failed. Conclusions: Clinical features which document or suggest long Roux limbs ( 150 cm) (recorded length of the Roux, pre-op BMI 55, and absolute weight loss) increased the likelihood of failure to access the right upper quadrant, even using the most recent enteroscopic devices. Avoiding failed peroral attempts at ERCP in RNYGB patients is highly desirable but cannot be absolutely predicted using these clinical features. Until technologies improve, the decision to attempt peroral ERCP initially or move directly to laparoscopic access should be based on a careful estimate of the likelihood of failure that is acceptable to the patient.
Databáze: OpenAIRE
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