Produção Nacional
Revisado por pares
Multicenter Evaluation of the Clinical Utility of Laparoscopy-Assisted ERCP in Patients with Rouxen-Y Gastric Bypass (RYGB)
2016; Lippincott Williams & Wilkins; Volume: 111; Linguagem: Inglês
10.14309/00000434-201610001-00299
ISSN1572-0241
AutoresAli Abbas, Benjamin L. Bick, Ihab I. El Hajj, Stuart Sherman, David L. Diehl, Brian C. Brauer, Mihir S. Wagh, Bruce D. Greenwald, Iris H. Lee, Lance Uradomo, Rebecca Burbridge, Alyson A. McGhan, J Zivný, Shahrad Hakimian, Marcelo Falcão, Paul R. Tarnasky, Christopher E. Forsmark, Dennis Yang, Anand Gupte, Shailendra Chauhan, Steven J. Hughes, Karen Saks, Brintha K. Enestvedt, Gennadiy Bakis, Alireza Sedarat, Adarsh M. Thaker, Rishi Pawa, John A. Evans, Thiruvengadam Muniraj, Priya A. Jamidar, Kartik Sampath, Timothy B. Gardner, Eduardo Guimarães Hourneaux de Moura, Almino Ramos, Marco Aurélio Santo, Andrew Nett, Richard S. Kwon, Alejandro L. Suarez, Gregory A. Coté, Badih Joseph Elmunzer, Kulwinder S. Dua, Murad Aburajab, Michael J. Nosler, Andrew Y. Wang, Daniel S. Strand, Vivek Kaul, Shivangi Kothari, Asad Ullah, Pushpack Taunk, Patrick Brady, Jordan Holmes, Rahul Pannala, Jeffrey L. Tokar, Demetrios Tzimas, Juan Carlos Bucobo, Brent W. Acker, Andrew S. Ross, Jen Higa, Peter V. Draganov,
Tópico(s)Abdominal Surgery and Complications
ResumoIntroduction: RYGB is the most common weight loss procedure in the United States. Standard ERCP is not feasible and enteroscopy assisted ERCP tends to be technically challenging with low success rate in these patients. Laparoscopy-assisted (lap-assist) ERCP has been proposed through small, single-center, case series. Therefore we conducted a multicenter, nationwide study to evaluate the feasibility, safety and outcomes of this approach. Methods: This is an IRB approved, retrospective study that included adult patients with RYGB undergoing lap-assist ERCP in 22 centers in the United States and 2 in Brazil. A standardized data entry form was distributed across all the centers to collect information about demographics, indications, operative details, success rate, and complications. Severity of complication was classified using the American Society for Gastrointestinal Endoscopy lexicon. Results: We included 388 patients with median age of 51 (Interquartile range (IQR) 41-60) and 84% females. Indication for lap-assist ERCP was biliary in 92% (stones 50%) and pancreatic in 8% (acute pancreatitis 94%). Success in reaching the papilla was achieved in 98%, cannulating the desired duct in 98%, and performing the desired intervention in 97%. Success in the disease state resolution after the intervention was 94%. The most common therapeutic interventions were biliary sphincterotomy (97%), stone extraction (45%), pancreatic stent placement (15%), and biliary stent placement (7%). Median total procedure time (laparoscopy + ERCP) was 152 (IQR 112-210) and median ERCP time was 39 (IQR 27-55) minutes. Median length of stay in the hospital was 2 (IQR 1-3) days. Complications were reported in 16% of the cases (9% laparoscopy and 6% ERCP related). Most common complications were pancreatitis (5%), infections (5%), cholangitis (1%) and perforation (1%). Majority (13.4%) were classified as mild, whereas 1.5% was classified as severe and one death was reported. Conclusion: Our large multicenter study indicates that lap-assist ERCP in patients with RYGB is highly successful with success rates compatible to standard ERCP in patients with normal upper GI tract anatomy. ERCP related complication rates appear comparable to conventional ERCP, but the overall complication rate was higher due to the added laparoscopy associated complications. Note: There are a total of 53 authors from 24 participating centers. Only 25 authors listed due to the abstract submission system limitation on the maximum authors number.
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