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An innovative technique using a percutaneously placed guidewire allows for higher success rate for ERCP compared to balloon enteroscopy assistance in Roux-en-Y gastric bypass anatomy

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Abstract

Background

Endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging in Roux-en-Y gastric bypass (RYGB). Current approaches either have high failure rate, are resource intensive, or invasive.

Objective

To describe successful adoption of an old technique for performance of ERCP in patients with RYGB anatomy employing enteroscopy with the assistance of a percutaneously placed guidewire, which facilitates both reaching and cannulating the major papilla.

Method

A retrospective cohort study in a tertiary-care center. We included patients with RYGB from 2015 to 2017 who underwent ERCP. We compared success rate and adverse events between rendezvous guidewire-assisted (RGA) and balloon-assisted enteroscopy (BAE) ERCP techniques.

Results

Thirty patients with RYGB underwent 62 ERCPs. The mean age was 62.2 ± 11 years with female predominance 83.3%. The procedures were performed using BAE 43/62 (69.3%), RGA 13/62 (21%), gastrostomy tube 5/62 (8.1%), and colonoscope 1/62 (1.6%). In patients with a native papilla (n = 37 ERCPs), clinical success rate with BAE was 36.8% compared to 100% with RGA (P < 0.001). There was no significant difference in bleeding (P = 0.17), post-ERCP pancreatitis (P = 0.4), or luminal perforation (P = not estimated) between the two techniques in native papilla. The mean procedure time with the RGA was significantly shorter than successful BAE with mean difference: 33 min (95% CI 8–57 min, P = 0.01). Twenty-five ERCPs were performed in eight patients with non-native papilla. BAE success rate in non-native papilla was 95.8%. The mean procedure time of the BAE in non-native papilla was 111 ± 60 min. Native papillae were associated with a significantly higher BAE failure rate compared to non-native papillae (OR: 12; 95% CI 1.44–99.7, P = 0.02).

Conclusion

In patients with RYGB, RGA appears to be highly successful and safe in achieving clinical success for patients with native papilla as compared to BAE.

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Abbreviations

AEs:

Adverse events

BAE:

Balloon-assisted enteroscopy

ERCP:

Endoscopic Retrograde Cholangiopancreatography

PEP:

Post-ERCP pancreatitis

RGA:

Rendezvous guidewire assisted

RYGB:

Roux-en-Y gastric bypass

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Ave., S.W., Rochester, MN, 55905, USA

    Tarek Sawas, Andrew C. Storm, Fateh Bazerbachi, Eric J. Vargas, Vinay Chandrasekhara, Michael J. Levy, John A. Martin, Bret T. Petersen, Mark D. Topazian & Barham K. Abu Dayyeh

  2. Division of Interventional Radiology, Mayo Clinic, Rochester, MN, USA

    Chad J. Fleming & James C. Andrews

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  1. Tarek Sawas
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  2. Andrew C. Storm
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Contributions

Study design: TS and BKA. Analysis of data: TS and BKA. Interpretation of data: TS and BKA. Writing and review of the manuscript: TS, ACS, JCA, CJF, FB, EJV, VC, MJL, JAM, BTP, MDT, and BKA.

Corresponding author

Correspondence to Barham K. Abu Dayyeh.

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Disclosures

Drs. Tarek Sawas, Andrew C. Storm, Fateh Bazerbachi, Chad J. Fleming, Eric J. Vargas, James C. Andrews, Michael J. Levy, and John A. Martin have no conflicts of interest or financial ties to disclose. Dr. Vinay Chandrasekhara is on the advisory Board Member for Interpace Diagnostics and shareholder of Nevakar Corporation. Dr. Mark D. Topazian has a grant funding from Celgene not relevant to this publication. Dr. Bret T. Petersen is a consultant for Boston scientific and Olympus America, Medical Advisory Board for Advanced Sterilization Products—J and J. Dr Barham K. Abu Dayyeh has research support and consultant for Boston Scientific and Speaker for Olympus and Johnson and Johnson.

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Sawas, T., Storm, A.C., Bazerbachi, F. et al. An innovative technique using a percutaneously placed guidewire allows for higher success rate for ERCP compared to balloon enteroscopy assistance in Roux-en-Y gastric bypass anatomy. Surg Endosc 34, 806–813 (2020). https://doi.org/10.1007/s00464-019-06832-9

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