EUS-directed transgastric endoscopic retrograde cholangiopancreatography versus laparoscopic-assisted ERCP versus deep enteroscopy-assisted ERCP for patients with RYGB

Abstract Background and study aims Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP) (EDGE) is a novel technique for managing pancreaticobiliary diseases in patients with a history of Roux-en-Y Gastric Bypass (RYGB). It has shown to have high technical success rates and fewer adverse events as compared to laparoscopic-assisted ERCP (LA-ERCP). We compared the technical success and clinical outcomes of EDGE vs. LA-ERCP vs. E-ERCP. Patients and methods A retrospective chart review was performed for 56 patients, of whom 18 underwent LA-ERCP, 12 underwent E-ERCP, and 26 had EDGE, and a comparison of technical success and complication rates was done. Results Baseline demographic characteristics of patients undergoing these procedures, including age and gender, were comparable. The technical success rate for patients in the EDGE group were 100 % (n = 26), compared with 94 % (n = 17) and 75 % (n = 9) in the LA-ERCP and E-ERCP groups (P = 0.02). In the EDGE group, 8 % of patients (n = 2) had bleeding, and 4 % of patients (n = 1) had lumen-apposing metal stent migration occur during the procedure. In the LA-ERCP group 6 % (n = 1) of patient had bleeding, 6 % (n = 1) post-ERCP pancreatitis and 6 % (n = 1) were diagnosed with an intra-abdominal infection post-procedure. Time to complete the EDGE procedure was significantly shorter at 79 ± 31 mins, compared with 158 ± 50 mins for LA-ERCP and 102 ± 43 mins for E-ERCP (P < 0.001). Conclusion EDGE is a novel procedure with short procedure times and an effective alternative to LA-ERCP and E-ERCP in management of pancreaticobiliary diseases in patients with a history of RYGB.

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SP6.1.7 Meta-analysis of procedural outcomes of laparoscopic-assisted endoscopic retrograde cholangiopancreatography in patients with previous Roux-en-Y gastric bypass surgery

British Journal of Surgery ◽

10.1093/bjs/znab361.134 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Shahab Hajibandeh ◽

Shahin Hajibandeh ◽

Moustafa Mansour ◽

Thomas Satyadas

Keyword(s):

Gastric Bypass ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Case Series ◽

Complication Rates ◽

Success Rates ◽

Technical Success ◽

Endoscopic Retrograde ◽

The Mean ◽

Laparoscopic Assisted ◽

Procedural Outcomes

Abstract Aims To investigate the procedural outcomes of laparoscopic-assisted endoscopic retrograde cholangiopancreatography (ERCP) in patients with previous Roux-en-Y gastric bypass (RYGB) surgery. Methods We performed a systematic review in accordance with PRISMA statement standards to identify all studies reporting procedural outcomes of laparoscopic-assisted ERCP in patients with previous RYGB. The ROBINS-I tool was used to assess the risk of bias of the included studies. Fixed-effect and random-effects models were applied to calculate pooled outcome data. Results A total of 17 case series, enrolling 256 patients, were included. The mean age of included patients was 49. The mean procedure time was 137 minutes (95% CI 102-172). In terms of procedural success rates, the overall technical success was 95.3% (95% CI 92.5-97.5,I2=0%), papillary access success was 95.3% (95% CI 92.5-97.5,I2=0%), cannulation success was 95.3% (95% CI 92.5-97.5,I2=0%), sphincterotomy success was 96.1% (95% CI 93.5-98.1,I2=0%), and stone removal success was 95.9% (95% CI 92.4-98.4, I2=0%). Conversion to open was required in 4.7% (95% CI 2.5-7.6,I2=0%). In terms of complications, pancreatitis occurred in 4.7% (95% CI 2.3-8,I2=17%), cholangitis in 1.7% (95% CI 0.5 to 3.6,I2=0%), and perforation in 3.7% (95% CI 1.8- 6.3,I2=0%). The length of hospital stay was 3 days (95% CI 2-4). Conclusions Laparoscopic-assisted ERCP seems to be feasible, effective, and a safe method to access the biliary tract in patients with previous RYGB as indicated by high technical success rates and low complication rates. There is a need for comparative evidence regarding outcomes of laparoscopic ERCP in comparison with alternative treatment options.

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Feasibility of balloon endoscope-assisted endoscopic retrograde cholangiopancreatography for the elderly

Endoscopy International Open ◽

10.1055/a-1216-1363 ◽

2020 ◽

Vol 08 (09) ◽

pp. E1202-E1211

Author(s):

Ryunosuke Hakuta ◽

Hirofumi Kogure ◽

Yousuke Nakai ◽

Tsuyoshi Hamada ◽

Tatsuya Sato ◽

...

Keyword(s):

Elderly Patients ◽

Endoscopic Retrograde Cholangiopancreatography ◽

The Elderly ◽

Group Differences ◽

Success Rates ◽

Technical Success ◽

Endoscopic Retrograde ◽

Elderly Individuals ◽

Technical Success Rate ◽

Surgically Altered Anatomy

Abstract Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) for patients with surgically altered anatomy is challenging. Recently, balloon endoscopy has been shown to facilitate ERCP for this population with a high technical success rate, but adverse events (AEs) are not uncommon. Compared to non-elderly patients, elderly patients may be at higher risk of AEs due to underlying comorbidities. The current study aimed to evaluate the feasibility of balloon endoscope-assisted ERCP (BE-ERCP) for the elderly. Patients and methods We retrospectively identified patients who underwent BE-ERCP between January 2010 and September 2019. For patients who underwent multiple procedures during the study period, the first session was analyzed. Early AEs associated with BE-ERCP were compared between elderly (≥ 75 years) and non-elderly patients. Results A total of 1,363 BE-ERCP procedures were performed, and 568 patients (211 elderly and 357 non-elderly) were included for the analyses. Technical success rates were high in both the elderly and non-elderly groups (80 % vs. 80 %, respectively). The rates of early AEs were similar between the groups (12 % vs. 9.0 % in the elderly and non-elderly group, respectively; P = 0.31). The mltivariable-adjusted odds ratio for early AEs comparing elderly to non-elderly patients was 1.36 (95 % confidence interval, 0.74–2.51; P = 0.32). Specifically, we did not observe between-group differences in rates of gastrointestinal perforation (2.4 % vs. 2.8 % in elderly and non-elderly groups, respectively; P = 0.99) and aspiration pneumonia (1.9 % vs. 0.6 %, P = 0.20). Conclusions BE-ERCP is a feasible procedure for elderly individuals with surgically altered anatomy.

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Prospective Comparison of Moderate Conscious Sedation and Anesthesia Assistance for the Performance of Endoscopic Retrograde Cholangiopancreatography (ERCP)

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2021/8892085 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Ahmed Akhter ◽

Ravi Patel ◽

Eric Nelsen ◽

Mark E. Benson ◽

Deepak V. Gopal ◽

...

Keyword(s):

General Anesthesia ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Conscious Sedation ◽

Medical Center ◽

Cost Savings ◽

Success Rates ◽

Procedure Time ◽

Technical Success ◽

Endoscopic Retrograde ◽

Prospective Comparison

Objectives. Recent trends have favored the use of anesthesia personnel more frequently for advanced endoscopic procedures. We hypothesize a selective sedation approach based on patient and procedural factors using either moderate conscious sedation (MCS) or general anesthesia (GA) will result in similar outcomes and safety with significant cost savings. Methods. A 12-month prospective study of all adult endoscopic retrograde cholangiopancreatography (ERCPs) performed at a tertiary medical center was enrolled. Technical success, cannulation rates, procedural related complications, procedure time, and cost were compared between MCS and GA. Results. A total of 876 ERCPs were included in the study with 74% performed with MCS versus 26% with GA. The intended intervention was completed successfully in 95% of cases with MCS versus 96% cases with GA ( p = 0.59). Cannulation success rates with MCS were 97.5 versus 97.8% with GA ( p = 0.81). Overall, adverse event rates were similar in both groups (MCS: 6.6% vs. GA: 9.2%, p = 0.21). Mean procedure time was less for MCS versus GA, 18.3 and 26 minutes, respectively ( p < 0.0001). Selective use of MCS vs. universal sedation with GA resulted in estimated savings of $8,190 per case and $4,735,202 per annum. Conclusions. Preselection of ERCP sedation of moderate conscious sedation versus general anesthesia based upon patient risk factors and planned therapeutic intervention allows for the majority of ERCPs to be completed with MCS with similar rates of technical success and improvement in resource utilization and cost savings compared to performing ERCPs universally with anesthesia assistance.

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Technical and clinical outcomes of endoscopic retrograde cholangiopancreatography (ERCP) procedures performed in patients with COVID-19

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284820980671 ◽

2020 ◽

Vol 13 ◽

pp. 175628482098067

Author(s):

Theodor Voiosu ◽

Andrei Voiosu ◽

Ivo Boškoski ◽

Marianna Arvanitakis ◽

Michiel Bronswijk ◽

...

Keyword(s):

Adverse Events ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Multivariable Analysis ◽

Secondary Outcome ◽

Control Group ◽

Minimal Risk ◽

Technical Failure ◽

Success Rates ◽

Technical Success ◽

Endoscopic Retrograde

Background: The unprecedented situation caused by the coronavirus disease 2019 (COVID-19) pandemic has profoundly affected endoscopic practice in regard to access, volume, and workflow. We aimed to assess the potential changes in the technical outcomes of endoscopic retrograde cholangiopancreatography (ERCP) procedures carried out in patients with confirmed SARS-CoV-2 infection. Methods: We conducted an international, multicenter, retrospective, matched case-control study of ERCP procedures carried out in patients with confirmed COVID-19. The main outcome was technical success of the procedure as assessed by the endoscopist, and the secondary outcome was the development of procedure-related adverse events. Each case was matched in a 1:4 ratio with controls extracted from each center’s database in order to identify relevant changes in outcome measures compared with the pre-pandemic era. Results: Eighteen procedures performed in 16 COVID-19 patients [14 men, 65 years (9–82)] and 67 controls were included in the final analysis. Technical success was achieved in 14/18 COVID-19 cases, which was significantly lower as compared with the control group (14/18 versus 64/67, p = 0.034), with an endoscopic reintervention required in 9/18 cases. However, the rate of procedure-related adverse events was low in both groups (1/18 versus 10/67, p = 0.44). On multivariable analysis, COVID-19 status remained the only risk factor for technical failure of the procedure [odds ratio of 19.9 (95% confidence interval 1.4–269.0)]. Conclusions: The COVID-19 pandemic has affected the volume and practice of ERCP, resulting in lower technical success rates without significantly impacting patient safety. Prioritizing cases and following recommendations on safety measures can ensure good outcome with minimal risk in dedicated centers.

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Safety and efficacy of arteriovenous fistula angioplasties performed by nephrologists: report from a Brazilian interventional nephrology center

Brazilian Journal of Nephrology ◽

10.1590/2175-8239-jbn-2021-0085 ◽

2021 ◽

Author(s):

Ricardo P. Franco ◽

Miguel C. Riella ◽

Domingos C. Chula ◽

Marcia T. de Alcântara ◽

Marcelo M. do Nascimento

Keyword(s):

Success Rate ◽

Low Income ◽

Complication Rates ◽

Technical Failure ◽

Success Rates ◽

Technical Success ◽

Safety And Efficacy ◽

Technical Success Rate ◽

Venous Stenosis ◽

First Choice

ABSTRACT Introduction: Arteriovenous fistulas (AVF) are the first choice vascular access for hemodialysis. However, they present a high incidence of venous stenosis leading to thrombosis. Although training in interventional nephrology may improve accessibility for treatment of venous stenosis, there is limited data on the safety and efficacy of this approach performed by trained nephrologists in low-income and developing countries. Methods: This study presents the retrospective results of AVF angioplasties performed by trained nephrologists in a Brazilian outpatient interventional nephrology center. The primary outcome was technical success rate (completion of the procedure with angioplasty of all stenoses) and secondary outcomes were complication rates and overall AVF patency. Findings: Two hundred fifty-six angioplasties were performed in 160 AVF. The technical success rate was 88.77% and the main cause of technical failure was venous occlusion (10%). The incidence of complications was 13.67%, with only one patient needing hospitalization and four accesses lost due to the presence of hematomas and/or thrombosis. Grade 1 hematomas were the most frequent complication (8.2%). The overall patency found was 88.2 and 80.9% at 180 and 360 days after the procedure, respectively. Conclusion: Our findings suggest that AVF angioplasty performed by trained nephrologists has acceptable success rates and patency, with a low incidence of major complications as well as a low need for hospitalization.

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Safety of endoscopic retrograde cholangiopancreatography in the pediatric population: a multicenter study

Endoscopy ◽

10.1055/a-1209-0155 ◽

2020 ◽

Author(s):

Clémence Mercier ◽

Mathieu Pioche ◽

Eliane Albuisson ◽

Thierry Ponchon ◽

Jean-Michel Gonzalez ◽

...

Keyword(s):

Adverse Events ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Multicenter Study ◽

Pediatric Population ◽

Tertiary Care ◽

Success Rates ◽

Endoscopic Retrograde ◽

Therapeutic Procedures ◽

Long Term Follow Up ◽

History Of

Introduction The aims of this retrospective multicenter study were to assess the technical success and adverse events of endoscopic retrograde cholangiopancreatography (ERCP) procedures in children in French and Belgian centers. Methods All children aged 1 day to 17 years who underwent ERCP between January 2008 and March 2019 in 15 tertiary care hospitals were retrospectively included. Results 271 children underwent 470 ERCP procedures. Clinical long-term follow-up was available for 72 % of our patients (340/470 procedures). The median age at intervention was 10.9 years. ERCP was therapeutic in 90 % (423/470) and diagnostic in cases of neonatal cholestasis in 10 % of the patients. The most common biliary indication was choledocholithiasis; the most common pancreatic indication was chronic pancreatitis. Biliary cannulation was successful in 92 % of cases (270/294); pancreatic cannulation in 96 % of cases (169/176); and planned therapeutic procedures in 92 % of cases (388/423). The overall complication rate was 19 % (65/340). The most common complication was post-ERCP pancreatitis (PEP) in 12 % of cases (40/340) and sepsis in 5 % (18/340). On univariate analyses, pancreatic stent removal was protective against PEP (odds ratio [OR] 0.1, 95 % confidence interval [CI] 0.01 – 0.75; P = 0.03), and sepsis was associated with history of liver transplantation (OR 7.27, 95 %CI 1.7 – 31.05; P = 0.01). Five patients had post-ERCP hemorrhage and two had intestinal perforation. All complications were managed with supportive medical care. There was no procedure-related mortality. Conclusion Our cohort demonstrates that ERCP can be performed safely with high success rates in many pancreaticobiliary diseases of children. The rate of adverse events was similar to that in previous reports.

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Long-term outcomes after endoscopic retrograde pancreatic drainage for symptomatic pancreaticojejunal anastomotic stenosis

Scientific Reports ◽

10.1038/s41598-021-84024-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Akihiko Kida ◽

Yukihiro Shirota ◽

Taro Kawane ◽

Hitoshi Omura ◽

Tatsuo Kumai ◽

...

Keyword(s):

Adverse Events ◽

Anastomotic Stenosis ◽

Technical Success ◽

Long Term Outcomes ◽

Endoscopic Retrograde ◽

Technical Success Rate ◽

Registration Number ◽

Clinical Trial Register

AbstractThere is limited evidence supporting the usefulness of endoscopic retrograde pancreatic drainage (ERPD) for symptomatic pancreaticojejunal anastomotic stenosis (sPJS). We examined the usefulness of ERPD for sPJS. We conducted a retrospective analysis of 10 benign sPJS patients. A forward-viewing endoscope was used in all sessions. Following items were evaluated: technical success, adverse events, and clinical outcome of ERPD. The technical success rate was 100% (10/10) in initial ERPD; 9 patients had a pancreatic stent (no-internal-flap: n = 4, internal-flap: n = 5). The median follow-up was 920 days. Four patients developed recurrence. Among them, 3 had a stent with no-internal-flap in initial ERPD, the stent migrated in 3 at recurrence, and a stent was not placed in 1 patient in initial ERPD. Four follow-up interventions were performed. No recurrence was observed in 6 patients. None of the stents migrated (no-internal-flap: n = 1, internal-flap: n = 5) and no stents were replaced due to stent failure. Stenting with no-internal-flap was associated with recurrence (p = 0.042). Mild adverse events developed in 14.3% (2/14). In conclusions, ERPD was performed safely with high technical success. Recurrence was common after stenting with no-internal-flap. Long-term stenting did not result in stent failure.Clinical trial register and their clinical registration number: Nos. 58-115 and R2-9.

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SpyGlass DS-guided lithotripsy for pancreatic duct stones in symptomatic treatment-refractory chronic calcifying pancreatitis

Endoscopy International Open ◽

10.1055/a-0808-4499 ◽

2019 ◽

Vol 07 (02) ◽

pp. E99-E103 ◽

Cited By ~ 8

Author(s):

Christian Gerges ◽

David Pullmann ◽

Farzan Bahin ◽

Markus Schneider ◽

Peter Siersema ◽

...

Keyword(s):

Pancreatic Duct ◽

Clinical Success ◽

Symptomatic Treatment ◽

Complication Rates ◽

Success Rates ◽

Technical Success Rate ◽

Extracorporeal Shock Wave ◽

Small Series ◽

Chronic Calcifying Pancreatitis ◽

Calcifying Pancreatitis

Abstract Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) and/or extracorporeal shock wave lithotripsy are first-line therapies for draining an obstructed pancreatic duct (PD) in painful chronic calcifying pancreatitis (CCP). Pancreaticoscopy has shown promising success rates in small series. Materials and methods This study was a retrospective analysis of a clinical database. Included were all digital single-operator digital video (SOV) pancreaticoscopy-guided interventions (n = 23) on CCP patients (n = 20) between 2015 and 2017. Success and complication rates were collected from the database. Clinical success was determined by assessing pain level score (NRS) and quality of life (QoL) using standardized questionnaires. Results Overall technical success rate (successful SOV-pancreaticoscopy and PD drainage) was 95 %. Adverse events occurred in 7 of 23 procedures (30 %) and included extravasation from the PD (n = 1), self-limiting post-sphincterotomy bleeding (n = 1) and post-ERCP pancreatitis (PEP) (n = 6). At 3- to 6-month follow-up, 95 % of patients reported improvement in symptoms and reduction in intake of analgesics. Mean NRS decreased from 5.4 (±1.6) to 2.8 (± 1.8) (P < 0.01). Clinical success was achieved in 95 % of patients. Conclusions Digital SOV-guided lithotripsy was found to be safe and effective in this highly selected population of CCP patients. PD decompression had a beneficial effect on pain reduction and QoL.

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Transcystic Removal of Common Bile Duct Stones in Surgically Altered Anatomy (Roux-en-Y Gastric Bypass)

Journal of Digestive Endoscopy ◽

10.1055/s-0041-1739970 ◽

2021 ◽

Vol 12 (03) ◽

pp. 172-174

Author(s):

Surakshith K. Thyloor ◽

Vikas Singla ◽

Pradeep Chowbey

Keyword(s):

Gastric Bypass ◽

Bile Duct ◽

Common Bile Duct ◽

Common Bile Duct Stones ◽

Bile Duct Stones ◽

Technical Success ◽

Endoscopic Retrograde ◽

Technical Success Rate ◽

Surgically Altered Anatomy ◽

Retrieval Device

AbstractEndoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy can be technically challenging. Various techniques have been described; however, the technical success rate depends on the type of reconstruction, length of the afferent limb, access to the papilla, availability of accessories, and adequate expertise. We describe successful transcystic removal of common bile duct stones in a patient with Roux-en-Y gastric bypass using cholangioscope and SpyGlass retrieval device at the time of cholecystectomy.

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Percutaneous transhepatic drainage is safe and effective in biliary obstruction—A single-center experience of 599 patients

PLoS ONE ◽

10.1371/journal.pone.0260223 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0260223

Author(s):

Bálint Kokas ◽

Attila Szijártó ◽

Nelli Farkas ◽

Miklós Ujváry ◽

Szabolcs Móri ◽

...

Keyword(s):

Success Rate ◽

Extrahepatic Bile Duct ◽

Treatment Algorithm ◽

Success Rates ◽

Technical Success ◽

Tertiary Referral Center ◽

Technical Success Rate ◽

Percutaneous Transhepatic Drainage ◽

First Choice ◽

Transhepatic Drainage

Background Historically, surgical bilioenteric bypass was the only treatment option for extrahepatic bile duct obstruction, but with technological advancements, percutaneous transhepatic drainage (PTD) and endoscopic solutions were introduced as a less invasive alternative. Endoscopic methods may lead to a decreasing indication of PTD in the future, but today it is still the standard treatment method, especially in hilar obstructions. Methods In our retrospective data analysis, we assessed technical success rate, reintervention rate, morbidity, mortality, and the learning curve of patients treated with PTD over 12 years in a tertiary referral center. Results 599 patients were treated with 615 percutaneous interventions. 94.5% (566/599) technical success rate; 2.7% (16/599) reintervention rate were achieved. 111 minor and 22 major complications occurred including 1 case of death. In perihilar obstruction, cholangitis were significantly more frequent in cases where endoscopic retrograde cholangiopancreatography had also been performed prior to PTD compared to PTD alone, with 39 (18.2%) and 15 (10.5%) occurrences, respectively. Discussion The results and especially the excellent success rates demonstrate that PTD is safe and effective, and it is appropriate for first choice in the treatment algorithm of perihilar stenosis. Ultimately, we concluded that PTD should be performed in experienced centers to achieve low mortality, morbidity, and high success rates.

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