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Comparison between Enteroscopy-Based and Laparoscopy-Assisted ERCP for Accessing the Biliary Tree in Patients with Roux-en-Y Gastric Bypass: Systematic Review and Meta-analysis

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Abstract

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.

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Authors and Affiliations

  1. 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

    Alberto Machado da Ponte-Neto, Lara M. de A. Coutinho, Iatagan Rocha Josino, Vitor Ottoboni Brunaldi, Diogo T. H. Moura, Paulo Sakai, Rogério Kuga & Eduardo G. H. de Moura

  2. São Paulo, Brazil

    Alberto Machado da Ponte-Neto

  3. Thoracic Surgery Department, Instituto do Coração (InCor, Heart Institute), University of Sao Paulo School of Medicine, São Paulo, Brazil

    Wanderley M. Bernardo

Authors
  1. Alberto Machado da Ponte-Neto
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  2. Wanderley M. Bernardo
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  3. Lara M. de A. Coutinho
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  4. Iatagan Rocha Josino
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  5. Vitor Ottoboni Brunaldi
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  6. Diogo T. H. Moura
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Correspondence to Alberto Machado da Ponte-Neto.

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The study was approved by the local institutional review board.

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da Ponte-Neto, A.M., Bernardo, W.M., de A. Coutinho, L.M. et al. Comparison between Enteroscopy-Based and Laparoscopy-Assisted ERCP for Accessing the Biliary Tree in Patients with Roux-en-Y Gastric Bypass: Systematic Review and Meta-analysis. OBES SURG 28, 4064–4076 (2018). https://doi.org/10.1007/s11695-018-3507-2

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