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Zhang Z, Liu L, Zhang C, Liu Z, Zhao Y, Qi H, Yang H, Wan B, Zhu M, Deng H, Feng J, Liu F, Guo Z, Yao P. Experience in laparoscopic transcystic common bile duct exploration for super-elderly patients with choledocholithiasis-A 96-year-old case report. Heliyon 2025; 11:e41204. [PMID: 39790872 PMCID: PMC11712018 DOI: 10.1016/j.heliyon.2024.e41204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 12/12/2024] [Accepted: 12/12/2024] [Indexed: 01/12/2025] Open
Abstract
Background Super-elderly patients with choledocholithiasis are considered to be at high risk for undergoing surgery. While laparoscopic transcystic common bile duct exploration (LTCBDE) is regarded as a challenging procedure for super-elderly patients with choledocholithiasis, there have been no reported cases of its use in super-elderly patients over the age of 96. Case summary This case study presents the case of a 96-year-old female patient with acute calculous cholecystitis and choledocholithiasis. Despite the presence of multiple high-risk comorbidities, the patient underwent with laparoscopic cholecystectomy (LC) plus LTCBDE, with appropriate perioperative safety measures in place, and made a full recovery, being discharged from the hospital on the seventh day following the operation. Conclusion The case study demonstrates the successful treatment of a 96-year-old patient with choledocholithiasis via LTCBDE, utilising skilled laparoscopic and choledochoscopic techniques along with robust perioperative safety measures. This achievement sets a historical precedent for the successful treatment of a 96-year-old patient with choledocholithiasis via LTCBDE, both domestically and internationally.
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Affiliation(s)
- Zongming Zhang
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing, 100073, China
- Key Laboratory of Geriatrics (Hepatobiliary Diseases), China General Technology Group, Beijing, 100073, China
| | - Limin Liu
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing, 100073, China
- Key Laboratory of Geriatrics (Hepatobiliary Diseases), China General Technology Group, Beijing, 100073, China
| | - Chong Zhang
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing, 100073, China
- Key Laboratory of Geriatrics (Hepatobiliary Diseases), China General Technology Group, Beijing, 100073, China
| | - Zhuo Liu
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing, 100073, China
- Key Laboratory of Geriatrics (Hepatobiliary Diseases), China General Technology Group, Beijing, 100073, China
| | - Yue Zhao
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing, 100073, China
- Key Laboratory of Geriatrics (Hepatobiliary Diseases), China General Technology Group, Beijing, 100073, China
| | - Hui Qi
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing, 100073, China
- Key Laboratory of Geriatrics (Hepatobiliary Diseases), China General Technology Group, Beijing, 100073, China
| | - Haiyan Yang
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing, 100073, China
- Key Laboratory of Geriatrics (Hepatobiliary Diseases), China General Technology Group, Beijing, 100073, China
| | - Baijiang Wan
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing, 100073, China
- Key Laboratory of Geriatrics (Hepatobiliary Diseases), China General Technology Group, Beijing, 100073, China
| | - Mingwen Zhu
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing, 100073, China
- Key Laboratory of Geriatrics (Hepatobiliary Diseases), China General Technology Group, Beijing, 100073, China
| | - Hai Deng
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing, 100073, China
- Key Laboratory of Geriatrics (Hepatobiliary Diseases), China General Technology Group, Beijing, 100073, China
| | - Jinqiu Feng
- Key Laboratory of Geriatrics (Hepatobiliary Diseases), China General Technology Group, Beijing, 100073, China
| | - Fucheng Liu
- Key Laboratory of Geriatrics (Hepatobiliary Diseases), China General Technology Group, Beijing, 100073, China
| | - Zhentian Guo
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing, 100073, China
- Key Laboratory of Geriatrics (Hepatobiliary Diseases), China General Technology Group, Beijing, 100073, China
| | - Peijie Yao
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing, 100073, China
- Key Laboratory of Geriatrics (Hepatobiliary Diseases), China General Technology Group, Beijing, 100073, China
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Gellért B, Rancz A, Hoferica J, Teutsch B, Sipos Z, Veres DS, Hegyi PJ, Ábrahám S, Hegyi P, Hritz I. Understanding the Role of Different ERCP Techniques in Post-Roux-en-Y Gastric Bypass Patients: a Systematic Review and Meta-analysis. Obes Surg 2025; 35:285-304. [PMID: 39671059 PMCID: PMC11717856 DOI: 10.1007/s11695-024-07459-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 08/01/2024] [Accepted: 08/06/2024] [Indexed: 12/14/2024]
Abstract
We aimed to compare enteroscopy-assisted ERCP (EA-ERCP), laparoscopy-assisted ERCP (LA-ERCP), and endoscopic ultrasound-directed ERCP (EDGE) in terms of safety and efficacy in post-Roux-en-Y gastric bypass patients. We conducted a rigorous analysis based on a predefined protocol (PROSPERO, CRD42022368788). Sixty-seven studies were included. The technical success rates were 77% (CI 69-83%) for EA-ERCP, 93% (CI 91-96%) for LA-ERCP, and 96% (CI 92-98%) for EDGE. Subgroup differences were significant between the EA-ERCP and other groups (p < 0.05). The overall adverse event rates were 13% (CI 8-22%), 19% (CI 14-24%), and 20% (CI 12-31%), respectively (p = 0.49). Our findings suggest that EDGE and LA-ERCP may be more effective and as safe as EA-ERCP.
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Affiliation(s)
- Bálint Gellért
- Centre for Translational Medicine, Semmelweis University, Üllői Út 26, 1085, Budapest, Hungary
- Department of Surgery, Transplantation and Gastroenterology, Division of Interventional Gastroenterology, Semmelweis University, Üllői Út 78, 1082, Budapest, Hungary
| | - Anett Rancz
- Centre for Translational Medicine, Semmelweis University, Üllői Út 26, 1085, Budapest, Hungary
- Department of Internal Medicine and Hematology, Medical School, Semmelweis University, Üllői Út 26, 1085, Budapest, Hungary
| | - Jakub Hoferica
- Centre for Translational Medicine, Semmelweis University, Üllői Út 26, 1085, Budapest, Hungary
- Jessenius Faculty of Medicine in Martin, Comenius University, Malá Hora 4A, 036 01, Martin-Záturčie, Slovakia
| | - Brigitta Teutsch
- Centre for Translational Medicine, Semmelweis University, Üllői Út 26, 1085, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Szigeti Út 12, 7624, Pécs, Hungary
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Korányi Sándor U. 2, 1082, Budapest, Hungary
| | - Zoltán Sipos
- Institute for Translational Medicine, Medical School, University of Pécs, Szigeti Út 12, 7624, Pécs, Hungary
- Institute of Bioanalysis, Medical School, University of Pécs, Honvéd Utca 1, 7624, Pécs, Hungary
| | - Dániel S Veres
- Department of Biophysics and Radiation Biology, Semmelweis University, Tűzoltó U. 37-47, 1094, Budapest, IX, Hungary
| | - Péter Jenő Hegyi
- Centre for Translational Medicine, Semmelweis University, Üllői Út 26, 1085, Budapest, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Tömő Utca 25-29, 1083, Budapest, Hungary
| | - Szabolcs Ábrahám
- Department of Surgery, Albert Szent-Györgyi Medical School, University of Szeged, H-6725 Tisza Utca 109, Szeged, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Üllői Út 26, 1085, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Szigeti Út 12, 7624, Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Tömő Utca 25-29, 1083, Budapest, Hungary
- Translational Pancreatology Research Group, Interdisciplinary Centre of Excellence for Research Development and Innovation, University of Szeged, H-6725 Tisza Utca 109, Szeged, Hungary
| | - István Hritz
- Department of Surgery, Transplantation and Gastroenterology, Division of Interventional Gastroenterology, Semmelweis University, Üllői Út 78, 1082, Budapest, Hungary.
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Saad B, Nasser M, Matar RH, Nakanishi H, Tosovic D, Than CA, Taha-Mehlitz S, Taha A. Safety and efficacy of LA-ERCP procedure following Roux-en-Y gastric bypass: a systematic review and meta-analysis. Surg Endosc 2023; 37:6682-6694. [PMID: 37479839 PMCID: PMC10462525 DOI: 10.1007/s00464-023-10276-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/02/2023] [Indexed: 07/23/2023]
Abstract
INTRODUCTION Rapid weight loss following Roux-en-Y gastric bypass surgery (RYGB) translates to an increased need for endoscopic retrograde cholangiopancreatography (ERCP) intervention. Laparoscopically Assisted Transgastric ERCP (LA-ERCP) has emerged to address the issue of accessing the excluded stomach. This study aims to evaluate the safety and efficacy of LA-ERCP procedure following RYGB. METHODS The Cochrane, EMBASE, SCOPUS, MEDLINE, Daily and Epub databases were searched from inception to May 2022 using the PRISMA guidelines. Eligible studies reported participants older than 18 years who underwent the LA-ERCP procedure, following RYGB, and outcomes of patients. RESULTS 27 unique studies met the inclusion criteria with 1283 patients undergoing 1303 LA-ERCP procedures. 81.9% of the patients were female and the mean age was 52.18 ± 13.38 years. The rate of concurrent cholecystectomy was 33.6%. 90.9% of procedures were undertaken for a biliary indication. The mean time between RYGB and LA-ERCP was 89.19 months. The most common intervention performed during the LA-ERCP was a sphincterotomy (94.3%). Mean total operative time was 130.48 min. Mean hospital length of stay was 2.697 days. Technical success was 95.3%, while clinical success was 93.8%. 294 complications were recorded with a 20.6% complication rate. The most frequent complications encountered were pancreatitis (6.8%), infection (6.1%), bleeding (3.4%), and perforation (2.5%). Rate of conversion to open laparotomy was 7%. CONCLUSION This meta-analysis presents preliminary evidence to suggest the safety and efficacy of LA-ERCP procedure following RYGB. Further investigations are warranted to evaluate the long-term efficacy of this procedure using studies with long-term patient follow-up.
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Affiliation(s)
- Baraa Saad
- St George's University of London, London, SW17 0RE, UK
| | - Maya Nasser
- St George's University of London, London, SW17 0RE, UK
| | - Reem H Matar
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, USA
| | | | - Danijel Tosovic
- School of Biomedical Sciences, The University of Queensland, St Lucia, Brisbane, 4072, Australia
| | - Christian A Than
- School of Biomedical Sciences, The University of Queensland, St Lucia, Brisbane, 4072, Australia
| | - Stephanie Taha-Mehlitz
- Clarunis, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, 4002, Basel, Switzerland
| | - Anas Taha
- Department of Biomedical Engineering, Faculty of Medicine, University of Basel, 4123, Allschwil, Switzerland.
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López-Uribe F, Camilo Naranjo CN, Botero JE, Moreno M, Londoño-Castillo J. Colangiopancreatografía endoscópica asistida por laparoscopia para el tratamiento de coledocolitiasis en pacientes con Y de Roux. REVISTA COLOMBIANA DE CIRUGÍA 2023. [DOI: 10.30944/20117582.2276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2025] Open
Abstract
Introducción. Los pacientes con antecedente de baipás gástrico que presentan coledocolitiasis no pueden ser tratados con la técnica convencional de colangiopancreatografía retrógrada endoscópica. En estos casos, la vía transgástrica abierta o asistida por laparoscopia, se convierte en una excelente alternativa a la exploración abierta de la vía biliar.
Métodos. Estudio retrospectivo que incluyó pacientes adultos con coledocolitiasis y antecedente de gastrectomía subtotal o baipás gástrico con Y de Roux, llevados a colangiopancreatografía endoscópica transgástrica laparoasistida, entre enero de 2019 y diciembre de 2021, en la Clínica CES de Medellín, Colombia.
Resultados. Se encontraron siete pacientes, todos con antecedente de baipás gástrico para el manejo de la obesidad. La tasa de identificación y canulación de la vía biliar y extracción de cálculos fue del 100 % mediante el abordaje transgástrico laparo-asistido.
Conclusión. De acuerdo con varias revisiones sistemáticas, esta técnica es relativamente fácil de implementar y segura, presentando una tasa de complicaciones inferior a 5 %. Se propone una variante de esta técnica.
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Belgau I, Johnsen G, Græslie H, Mårvik R, Nymo S, Bjerkan K, Hyldmo Å, Klöckner C, Kulseng B, Hoff D, Sandvik J. Frequency of cholelithiasis in need of surgical or endoscopic treatment a decade or more after Roux-en-Y gastric bypass. Surg Endosc 2023; 37:1349-1356. [PMID: 36203112 PMCID: PMC9944031 DOI: 10.1007/s00464-022-09676-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/24/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Symptomatic cholelithiasis requiring treatment is a known side effect after Roux-en-Y gastric bypass (RYGB), but reported rates vary greatly. The objectives for this study were to evaluate the long-term frequency of surgical or endoscopic treatment for symptomatic cholelithiasis 10-15 years after RYGB and its relation to self-reported abdominal pain. METHODS Observational data from 546 patients who underwent RYGB at public hospitals in Central Norway between March 2003 and December 2009 were analyzed. RESULTS Median follow-up was 11.5 (range 9.1-16.8) years. Sixty-five (11.9%) patients had undergone cholecystectomy prior to RYGB. Out of the 481 patients with intact gallbladder, 77 (16.0%) patients underwent cholecystectomy and six (1.2%) patients had treatment for choledocholithiasis during the observation period. Median time from RYGB to cholecystectomy or treatment of choledocholithiasis was 51 (range 1-160) and 109 (range 10-151) months, respectively. Female sex was associated with an increased risk of subsequent cholecystectomy [OR (95% CI) 2.88 (1.31-7.15)], p < 0.05. There was a higher frequency of self-reported abdominal pain at follow-up [OR (95% CI) 1.92 (1.25-2.93)] among patients who underwent cholecystectomy before or after RYGB. CONCLUSION With a median follow-up of more than 11 years after RYGB, one in six patients with an intact gallbladder at time of RYGB underwent cholecystectomy, and 1.1% of the patients needed surgical or endoscopic treatment for choledocholithiasis. Patients with a history of cholecystectomy reported a higher frequency of abdominal pain.
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Affiliation(s)
- Ingrid Belgau
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Gjermund Johnsen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway ,Norwegian National Advisory Unit on Advanced Laparoscopic Surgery, Clinic of Surgery, St. Olav’s University Hospital, Trondheim, Norway
| | - Hallvard Græslie
- Clinic of Surgery, Nord-Trøndelag Hospital Trust, Namsos Hospital, Namsos, Norway
| | - Ronald Mårvik
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway ,Norwegian National Advisory Unit on Advanced Laparoscopic Surgery, Clinic of Surgery, St. Olav’s University Hospital, Trondheim, Norway
| | - Siren Nymo
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway ,Clinic of Surgery, Nord-Trøndelag Hospital Trust, Namsos Hospital, Namsos, Norway
| | - Kirsti Bjerkan
- Faculty of Social Science and History, Volda University College, Volda, Norway ,Department of Surgery, Møre and Romsdal Hospital Trust, Ålesund Hospital, Ålesund, Norway
| | - Åsne Hyldmo
- Centre for Obesity Research, Clinic of Surgery, St. Olav’s University Hospital, Prinsesse Kristina’s Gate 3, 7030 Trondheim, Norway
| | - Christian Klöckner
- Centre for Obesity Research, Clinic of Surgery, St. Olav’s University Hospital, Prinsesse Kristina’s Gate 3, 7030 Trondheim, Norway
| | - Bård Kulseng
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Dag Hoff
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway ,Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Jorunn Sandvik
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway. .,Department of Surgery, Møre and Romsdal Hospital Trust, Ålesund Hospital, Ålesund, Norway. .,Centre for Obesity Research, Clinic of Surgery, St. Olav's University Hospital, Prinsesse Kristina's Gate 3, 7030, Trondheim, Norway.
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Gkolfakis P, Papaefthymiou A, Facciorusso A, Tziatzios G, Ramai D, Dritsas S, Florou T, Papanikolaou IS, Hassan C, Repici A, Triantafyllou K, Aabakken L, Devière J, Beyna T, Arvanitakis M. Comparison between Enteroscopy-, Laparoscopy- and Endoscopic Ultrasound-Assisted Endoscopic Retrograde Cholangio-Pancreatography in Patients with Surgically Altered Anatomy: A Systematic Review and Meta-Analysis. Life (Basel) 2022; 12:1646. [PMID: 36295081 PMCID: PMC9605390 DOI: 10.3390/life12101646] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/10/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND AIMS Endoscopic retrograde cholangiopancreatography (ERCP), in surgically altered anatomy (SAA), can be challenging and the optimal technique selection remains debatable. Most common foregut interventions resulting to this burden consist of Billroth II gastrectomy, Whipple surgery and Roux-en-Y anastomoses, including gastric by-pass. This systematic review, with meta-analysis, aimed to compare the rates of successful enteroscope-assisted (EA)-, endosonography-directed transgastric- (EDGE), and laparoscopy-assisted (LA)-ERCP. METHODS A systematic research (Medline) was performed for relative studies, through January 2022. The primary outcome was technical success, defined as approaching the ampulla site. Secondary outcomes included the desired duct cannulation, successful therapeutic manipulations, and complication rates. We performed meta-analyses of pooled data, and subgroup analysis considering the EA-ERCP subtypes (spiral-, double and single balloon-enteroscope). Pooled rates are reported as percentages with 95% Confidence Intervals (95%CIs). RESULTS Seventy-six studies were included (3569 procedures). Regarding primary outcome, EA-ERCP was the least effective [87.3% (95%CI: 85.3-89.4); I2: 91.0%], whereas EDGE and LA-ERCP succeeded in 97.9% (95%CI: 96.4-99.4; I2: 0%) and 99.1% (95%CI: 98.6-99.7; I2: 0%), respectively. Similarly, duct cannulation and therapeutic success rates were 74.7% (95%CI: 71.3-78.0; I2: 86.9%) and 69.1% (95%CI: 65.3-72.9; I2: 91.8%) after EA-ERCP, 98% (95%CI: 96.5-99.6; I2: 0%) and 97.9% (95%CI: 96.3-99.4) after EDGE, and 98.6% (95%CI: 97.9-99.2; I2: 0%) and 98.5% (95%CI: 97.8-99.2; I2: 0%) after LA-ERCP, respectively. The noticed high heterogeneity in EA-ERCP results probably reflects the larger number of included studies, the different enteroscopy modalities and the variety of surgical interventions. Comparisons revealed the superiority of LA-ERCP and EDGE over EA-ERCP (p ≤ 0.001) for all success-related outcomes, though LA-ERCP and EDGE were comparable (p ≥ 0.43). ERCP with spiral-enteroscope was inferior to balloon-enteroscope, while the type of the balloon-enteroscope did not affect the results. Most adverse events were recorded after LA-ERCP [15.1% (95%CI: 9.40-20.8); I2: 87.1%], and EDGE [13.1% (95%CI: 7.50-18.8); I2: 48.2%], significantly differing from EA-ERCP [5.7% (95%CI: 4.50-6.80); p ≤ 0.04; I2: 64.2%]. CONCLUSIONS LA-ERCP and EDGE were associated with higher technical, cannulation, and therapeutic success compared to EA-ERCP, though accompanied with more adverse events.
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Affiliation(s)
- Paraskevas Gkolfakis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium
| | | | - Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Georgios Tziatzios
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 124 62 Chaidari, Greece
| | - Daryl Ramai
- Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT 84132, USA
| | - Spyridon Dritsas
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil BA21 4AT, UK
| | - Theodosia Florou
- Department of Gastroenterology, University Hospital of Larissa, 411 10 Larissa, Greece
| | - Ioannis S. Papanikolaou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 124 62 Chaidari, Greece
| | - Cesare Hassan
- Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Alessandro Repici
- Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 124 62 Chaidari, Greece
| | - Lars Aabakken
- GI Endoscopy Unit, Institute of Clinical Medicine, Oslo University Hospital, 0372 Oslo, Norway
| | - Jacques Devière
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium
| | - Torsten Beyna
- Department of Internal Medicine, Evagelisches Krankenhaus Düsseldorf, 40225 Düsseldorf, Germany
| | - Marianna Arvanitakis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium
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7
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Connell M, Sun WYL, Mocanu V, Dang JT, Kung JY, Switzer NJ, Birch DW, Karmali S. Management of choledocholithiasis after Roux-en-Y gastric bypass: a systematic review and pooled proportion meta-analysis. Surg Endosc 2022; 36:6868-6877. [PMID: 35041054 DOI: 10.1007/s00464-022-09018-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 01/03/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Several therapeutic modalities have been proposed for the management of choledocholithiasis (CDL) following Roux-en-Y gastric bypass (RYGB), yet debate exists regarding the optimal management. The purpose of our study was to review the current literature to compare the efficacy of various techniques in the management of CDL post-RYGB. METHODS A comprehensive search of multiple databases was conducted. Studies reporting on the management of CDL in patients post-RYGB and including at least 5 patients were eligible for inclusion. The primary outcome was successful stone clearance. Secondary outcomes included procedure duration, length of hospital stay, and adverse events. RESULTS Of 3259 identified studies, 53 studies involving 857 patients were included in the final analysis. The mean age was 54.4 years (SD 7.05), 78.8% were female (SD 13.6%), and the average BMI was 30.8 kg/m2 (SD 6.85). Procedures described included laparoscopy-assisted ERCP (LAERCP), balloon-assisted enteroscopy (BAE), ultrasound-directed transgastric ERCP (EDGE), laparoscopic common bile duct exploration (LCBDE), EUS-guided intra-hepatic puncture with antegrade clearance (EGHAC), percutaneous trans-hepatic biliary drainage (PTHBD), and rendezvous guidewire-associated (RGA) ERCP. High rates of successful stone clearance were observed with LAERCP (1.00; 95% CI 0.99-1.00; p = 0.47), EDGE (0.97; 95% CI 0.9-1.00; p = 0.54), IGS ERCP (1.00; 95% CI 0.87-1.00), PTHBD (1.0; 95% CI 0.96-1.00), and LCBDE (0.99; 95% CI 0.93-1.00, p < 0.001). Lower rates of stone clearance were observed with BAE (61.5%; 95%CI 44.3-76.3, p = 0.188) and EGHAC (74.0%; 95% CI 42.9-91.5, p = 0.124). Relative to EDGE, LAERCP had a longer procedure duration (133.1 vs. 67.4 min) but lower complication rates (12.8% vs. 24.3%). CONCLUSION LAERCP and EDGE had high rates of success in the management of CDL post-RYGB. LAERCP had fewer complications but was associated with longer procedure times. BAE had lower success rates than both LAERCP and EDGE.
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Affiliation(s)
- Matthew Connell
- Division of General Surgery, University of Alberta, Edmonton, AB, Canada
| | - Warren Y L Sun
- Division of General Surgery, University of Alberta, Edmonton, AB, Canada.
| | - Valentin Mocanu
- Division of General Surgery, University of Alberta, Edmonton, AB, Canada
| | - Jerry T Dang
- Division of General Surgery, University of Alberta, Edmonton, AB, Canada
| | - Janice Y Kung
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Noah J Switzer
- Division of General Surgery, University of Alberta, Edmonton, AB, Canada
| | - Daniel W Birch
- Division of General Surgery, University of Alberta, Edmonton, AB, Canada
| | - Shahzeer Karmali
- Division of General Surgery, University of Alberta, Edmonton, AB, Canada
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Popowicz A, Sanamrad S, Darkahi B, Zacharias R, Sandblom G. Management of Common Bile Duct Stones Encountered During Cholecystectomy in Patients With Previous Gastric Bypass. Front Surg 2021; 8:789231. [PMID: 34957208 PMCID: PMC8694057 DOI: 10.3389/fsurg.2021.789231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Rapid weight loss following gastric bypass (GBP) predisposes to the development of gallstones, and in those who develop gallstone disease there is a high prevalence of common bile duct stones (CBDS). Furthermore, in these patients, CBDS are difficult to extract due to the altered upper gastrointestinal anatomy following GBP. The aim of the present study was to assess outcome after various management methods applied in the counties of Stockholm and Uppsala, Sweden. Methods: Data from the Swedish Register for Gallstone Surgery and ERCP (GallRiks) and the Swedish Obesity Surgery Register (SoReg) were crossmatched to identify all patients who had undergone gallstone surgery after GBP, where CBDS were found at intraoperative cholangiography, in the Stockholm and Uppsala counties 2009-2013. A retrospective review of patient records was performed for all patients identified. Results: In all, 55 patients were identified. These were managed as follows: expectancy (N = 11); transgastric ERCP (N = 2); laparoscopic choledochotomy (N = 3); open choledochotomy (N = 5); transcystic stone extraction (N = 12); and other approach (N = 13). In nine cases, data on management could not be found. There were nine cases of minor postoperative complication. No retained stones were registered. The operation time was longer for transgastric ERCP (p = 0.002), and the postoperative stay was longer following open and laparoscopic choledochotomy (p < 0.001). There was no statistically significant difference between any of the methods regarding the incidence of postoperative complications (p = 0.098). Discussion: Further development of techniques for managing CBDS discovered in patients undergoing cholecystectomy after previous GBP are needed, as well as more comparative studies with greater statistical power.
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Affiliation(s)
- Agnieszka Popowicz
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
- Section of Acute and Trauma Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Susanne Sanamrad
- Department of Emergency Medicine, Capio S:t Göran Hospital, Stockholm, Sweden
| | - Bahman Darkahi
- Department of Surgery, Enköping Hospital, Enköping, Sweden
| | - Rebecka Zacharias
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Gabriel Sandblom
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Södersjukhuset, Stockholm, Sweden
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Tringali A, Costa D, Fugazza A, Colombo M, Khalaf K, Repici A, Anderloni A. Endoscopic management of difficult common bile duct stones: Where are we now? A comprehensive review. World J Gastroenterol 2021; 27:7597-7611. [PMID: 34908801 PMCID: PMC8641054 DOI: 10.3748/wjg.v27.i44.7597] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/23/2021] [Accepted: 11/18/2021] [Indexed: 02/06/2023] Open
Abstract
Endoscopic management for difficult common bile duct (CBD) stones still presents a challenge for several reasons, including anatomic anomalies, patients’ individual conditions and stone features. In recent years, variable methods have emerged that have attributed to higher stone removal success rates, reduced cost and lower adverse events. In this review, we outline a stepwise approach in CBD stone management. As first line therapy, endoscopic sphincterotomy and large balloon dilation are recommended, due to a 30%-50% reduction of the use of mechanical lithotripsy. On the other hand, cholangioscopy-assisted lithotripsy has been increasingly reported as an effective and safe alternative technique to mechanical lithotripsy but remains to be reserved in special settings due to limited large-scale evidence. As discussed, findings suggest that management needs to be tailored to the patient’s characteristics and anatomical conditions. Furthermore, we evaluate the management of CBD stones in various surgical altered anatomy (Billroth II, Roux-en-Y and Roux-en-Y gastric bypass). Moreover, we could conclude that cholangioscopy-assisted lithotripsy needs to be evaluated for primary use, rather than following a failed management option. In addition, we discuss the importance of dissecting other techniques, such as the primary use of interventional endoscopic ultrasound for the management of CBD stones when other techniques have failed. In conclusion, we recognize that endoscopic sphincterotomy and large balloon dilation, mechanical lithotripsy and intraductal lithotripsy substantiate an indication to the management of difficult CBD stones, but emerging techniques are in rapid evolution with encouraging results.
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Affiliation(s)
- Alberto Tringali
- Gastroenterology and Endoscopy Unit, Department of Medicine, Conegliano Hospital, ULSS 2 Marca Trevigiana, Conegliano 31015, Italy
| | - Deborah Costa
- Gastroenterology and Endoscopy Unit, Department of Medicine, Conegliano Hospital, ULSS 2 Marca Trevigiana, Conegliano 31015, Italy
| | - Alessandro Fugazza
- Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Research Hospital IRCCS, Rozzano 20089, Milan, Italy
| | - Matteo Colombo
- Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Research Hospital IRCCS, Rozzano 20089, Milan, Italy
| | - Kareem Khalaf
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20072, Milan, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Research Hospital IRCCS, Rozzano 20089, Milan, Italy
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Research Hospital IRCCS, Rozzano 20089, Milan, Italy
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