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

Tarek Sawas, Andrew C. Storm, Fateh Bazerbachi, Chad J. Fleming, Eric J. Vargas, Vinay Chandrasekhara, James C. Andrews, Michael J. Levy, John A. Martin, Bret Thomas Petersen, Mark Topazian, Barham K. Abu Dayyeh

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalSurgical Endoscopy
DOIs
StatePublished - Jan 1 2019

Fingerprint

Gastric Bypass
Endoscopic Retrograde Cholangiopancreatography
Anatomy
Colonoscopes
Gastrostomy
Balloon Enteroscopy
Tertiary Care Centers
Pancreatitis
Cohort Studies
Retrospective Studies
Hemorrhage

Keywords

  • ERCP
  • Rendezvous guidewire assisted
  • RYGB

ASJC Scopus subject areas

  • Surgery

Cite this

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. / Sawas, Tarek; Storm, Andrew C.; Bazerbachi, Fateh; Fleming, Chad J.; Vargas, Eric J.; Chandrasekhara, Vinay; Andrews, James C.; Levy, Michael J.; Martin, John A.; Petersen, Bret Thomas; Topazian, Mark; Abu Dayyeh, Barham K.

In: Surgical Endoscopy, 01.01.2019.

Research output: Contribution to journalArticle

Sawas, Tarek ; Storm, Andrew C. ; Bazerbachi, Fateh ; Fleming, Chad J. ; Vargas, Eric J. ; Chandrasekhara, Vinay ; Andrews, James C. ; Levy, Michael J. ; Martin, John A. ; Petersen, Bret Thomas ; Topazian, Mark ; Abu Dayyeh, Barham K. / 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. In: Surgical Endoscopy. 2019.
@article{12329bbaa079477ab42c37be36c648ea,
title = "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",
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.",
keywords = "ERCP, Rendezvous guidewire assisted, RYGB",
author = "Tarek Sawas and Storm, {Andrew C.} and Fateh Bazerbachi and Fleming, {Chad J.} and Vargas, {Eric J.} and Vinay Chandrasekhara and Andrews, {James C.} and Levy, {Michael J.} and Martin, {John A.} and Petersen, {Bret Thomas} and Mark Topazian and {Abu Dayyeh}, {Barham K.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s00464-019-06832-9",
language = "English (US)",
journal = "Surgical Endoscopy",
issn = "0930-2794",
publisher = "Springer New York",

}

TY - JOUR

T1 - 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

AU - Sawas, Tarek

AU - Storm, Andrew C.

AU - Bazerbachi, Fateh

AU - Fleming, Chad J.

AU - Vargas, Eric J.

AU - Chandrasekhara, Vinay

AU - Andrews, James C.

AU - Levy, Michael J.

AU - Martin, John A.

AU - Petersen, Bret Thomas

AU - Topazian, Mark

AU - Abu Dayyeh, Barham K.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - ERCP

KW - Rendezvous guidewire assisted

KW - RYGB

UR - http://www.scopus.com/inward/record.url?scp=85066486854&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85066486854&partnerID=8YFLogxK

U2 - 10.1007/s00464-019-06832-9

DO - 10.1007/s00464-019-06832-9

M3 - Article

AN - SCOPUS:85066486854

JO - Surgical Endoscopy

JF - Surgical Endoscopy

SN - 0930-2794

ER -