F Fortunati, L Monino, P Deprez, H Piessevaux, T Moreels
{"title":"Endoscopic retrograde cholangiopancreatography in patients with different types of total and partial gastrectomy.","authors":"F Fortunati, L Monino, P Deprez, H Piessevaux, T Moreels","doi":"10.51821/88.1.13779","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and study aims: </strong>Endoscopic retrograde cholangiopancreatography (ERCP) in surgically altered anatomy patients is challenging. We analyzed ERCP procedures after gastric surgery with maintained Vater's papilla: total/partial gastrectomy Roux-en-Y, Billroth II gastrectomy, sleeve gastrectomy and gastrojejunostomy.</p><p><strong>Methods: </strong>Monocentric retrospective analysis of prospective ERCP cohort in surgically altered gastric anatomy (SAGA) patients with maintained Vater's papilla between 2006 and 2024.</p><p><strong>Results: </strong>186 ERCP procedures in 110 patients with SAGA proportions: 37% total gastrectomy Roux-en-Y, 32% Billroth II partial gastrectomy, 15% partial gastrectomy Roux-en-Y, 11% gastrojejunostomy, 4% sleeve gastrectomy and 1% less common reconstructions. ERCP indications were mainly biliary (87%). Total technical success was 82% with lower technical success in Roux-en-Y gastric surgery (73%) vs gastric surgery without Rouxen- Y (92%). 13 adverse events (GRADE II - IV) were encountered (7%) with 1 mortality due to perprocedural cardiac arrest. Sleeve gastrectomy allowed the use of conventional duodenoscopes with 100% technical success. In Billroth II patients both duodenoscopes, gastroscopes and colonoscopes as well as balloon-assisted enteroscopes were used with high technical success (94-100%), as well as in gastrojejunostomy patients (57-100%). For Roux-en-Y reconstructions, only single-balloon enteroscopes were used with acceptable success (75% in partial and 74% in total gastrectomy Roux-en-Y).</p><p><strong>Conclusions: </strong>ERCP in SAGA patients is challenging requiring different types of endoscopes, especially after Roux-en-Y total or partial gastrectomy with lower technical success as compared tods Billroth II gastrectomy, sleeve gastrectomy and gastrojejunostomy. Adverse event rates are comparable to ERCP procedures in patients with normal anatomy.</p>","PeriodicalId":7322,"journal":{"name":"Acta gastro-enterologica Belgica","volume":"88 1","pages":"23-30"},"PeriodicalIF":1.3000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Acta gastro-enterologica Belgica","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.51821/88.1.13779","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background and study aims: Endoscopic retrograde cholangiopancreatography (ERCP) in surgically altered anatomy patients is challenging. We analyzed ERCP procedures after gastric surgery with maintained Vater's papilla: total/partial gastrectomy Roux-en-Y, Billroth II gastrectomy, sleeve gastrectomy and gastrojejunostomy.
Methods: Monocentric retrospective analysis of prospective ERCP cohort in surgically altered gastric anatomy (SAGA) patients with maintained Vater's papilla between 2006 and 2024.
Results: 186 ERCP procedures in 110 patients with SAGA proportions: 37% total gastrectomy Roux-en-Y, 32% Billroth II partial gastrectomy, 15% partial gastrectomy Roux-en-Y, 11% gastrojejunostomy, 4% sleeve gastrectomy and 1% less common reconstructions. ERCP indications were mainly biliary (87%). Total technical success was 82% with lower technical success in Roux-en-Y gastric surgery (73%) vs gastric surgery without Rouxen- Y (92%). 13 adverse events (GRADE II - IV) were encountered (7%) with 1 mortality due to perprocedural cardiac arrest. Sleeve gastrectomy allowed the use of conventional duodenoscopes with 100% technical success. In Billroth II patients both duodenoscopes, gastroscopes and colonoscopes as well as balloon-assisted enteroscopes were used with high technical success (94-100%), as well as in gastrojejunostomy patients (57-100%). For Roux-en-Y reconstructions, only single-balloon enteroscopes were used with acceptable success (75% in partial and 74% in total gastrectomy Roux-en-Y).
Conclusions: ERCP in SAGA patients is challenging requiring different types of endoscopes, especially after Roux-en-Y total or partial gastrectomy with lower technical success as compared tods Billroth II gastrectomy, sleeve gastrectomy and gastrojejunostomy. Adverse event rates are comparable to ERCP procedures in patients with normal anatomy.
期刊介绍：
The Journal Acta Gastro-Enterologica Belgica principally publishes peer-reviewed original manuscripts, reviews, letters to editors, book reviews and guidelines in the field of clinical Gastroenterology and Hepatology, including digestive oncology, digestive pathology, as well as nutrition. Pure animal or in vitro work will not be considered for publication in the Journal. Translational research papers (including sections of animal or in vitro work) are considered by the Journal if they have a clear relationship to or relevance for clinical hepato-gastroenterology (screening, disease mechanisms and/or new therapies). Case reports and clinical images will be accepted if they represent an important contribution to the description, the pathogenesis or the treatment of a specific gastroenterology or liver problem. The language of the Journal is English. Papers from any country will be considered for publication. Manuscripts submitted to the Journal should not have been published previously (in English or any other language), nor should they be under consideration for publication elsewhere. Unsolicited papers are peer-reviewed before it is decided whether they should be accepted, rejected, or returned for revision. Manuscripts that do not meet the presentation criteria (as indicated below) will be returned to the authors. Papers that go too far beyond the scope of the journal will be also returned to the authors by the editorial board generally within 2 weeks. The Journal reserves the right to edit the language of papers accepted for publication for clarity and correctness, and to make formal changes to ensure compliance with AGEB’s style. Authors have the opportunity to review such changes in the proofs.
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