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Lee DS, Byeon JS, Kim SG, Kim JW, Lee KL, Jeong JB, Jung YJ, Kang HW. Efficacy of an assistive guide tube for improved endoscopic access to gastrointestinal lesions: an in vivo study in a porcine model. Clin Endosc 2024; 57:82-88. [PMID: 38302248 PMCID: PMC10834288 DOI: 10.5946/ce.2022.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 11/30/2022] [Accepted: 01/02/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND/AIMS Guide tube-assisted endoscopy for procedures that require repeated endoscopic access is safer and more effective than conventional endoscopy. However, its effectiveness has not been confirmed in animal studies. We assessed the usefulness of guide tube-assisted endoscopic procedures in an in vivo porcine model. METHODS Five different guide tube-assisted endoscopic procedures were performed by experienced endoscopists on a pig weighing 32 kg. To evaluate the efficacy of these procedures, we compared the endoscopic approach time when a guide tube was used to that when it was not. Additional endoscopic procedures using a guide tube were performed, including multiple foreign body extractions, multiple polypectomies, and multiple submucosal dissections. To evaluate safety, we compared the insertion force into the proximal esophagus between the guide tube and conventional overtube methods. RESULTS Using the endoscopic approach with a guide tube required a shorter average approach time to reach the three target lesions than when using the endoscopic approach without a guide tube (p<0.001). Compared to the conventional overtube method, the guide tube method produced a lower average resistance during insertion into the upper esophagus (p<0.001). CONCLUSION Guide tube-assisted endoscopic procedures are effective and safe for repeated endoscopic access in an in vivo porcine model.
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Affiliation(s)
- Dong Seok Lee
- Department of Gastroenterology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
- Department of Gastroenterology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Gyun Kim
- Department of Gastroenterology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Won Kim
- Department of Gastroenterology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Kook Lae Lee
- Department of Gastroenterology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Bong Jeong
- Department of Gastroenterology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Jin Jung
- Department of Gastroenterology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hyoun Woo Kang
- Department of Gastroenterology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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Gomez G. The Evaluation and Management of Suspicious Gastric Lesions Following Bariatric Surgery. Surg Clin North Am 2017; 97:467-474. [PMID: 28325198 DOI: 10.1016/j.suc.2016.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Obesity has reached epidemic proportions worldwide and is associated with a higher mortality from several diseases, including adenocarcinoma of the esophagus and of the gastric cardia. Increased body mass index is associated with an increased incidence of gastroesophageal reflux disease (GERD), Barrett metaplasia, and adenocarcinoma of the cardia. Bariatric surgery remains the most effective therapy for morbid obesity and has the potential to improve weight-related GERD. A high index of suspicion is paramount for early detection of foregut neoplasia after bariatric surgery.
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Affiliation(s)
- Guillermo Gomez
- General Surgery, The University of Texas Medical Branch, Galveston, TX, USA.
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Painter TJ, Teixeira AF, Jawad MA. Pyloric stenosis after a Roux-en-Y gastric bypass: a case report. Surg Obes Relat Dis 2014; 11:e9-10. [PMID: 25541110 DOI: 10.1016/j.soard.2014.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 09/16/2014] [Indexed: 01/08/2023]
Affiliation(s)
- Thomas John Painter
- Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health, Orlando, Florida
| | - Andre F Teixeira
- Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health, Orlando, Florida
| | - Muhammad A Jawad
- Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health, Orlando, Florida.
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Sánchez-Capilla AD, De La Torre-Rubio P, Redondo-Cerezo E. New insights to occult gastrointestinal bleeding: From pathophysiology to therapeutics. World J Gastrointest Pathophysiol 2014; 5:271-283. [PMID: 25133028 PMCID: PMC4133525 DOI: 10.4291/wjgp.v5.i3.271] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 06/01/2014] [Accepted: 06/18/2014] [Indexed: 02/06/2023] Open
Abstract
Obscure gastrointestinal bleeding is still a clinical challenge for gastroenterologists. The recent development of novel technologies for the diagnosis and treatment of different bleeding causes has allowed a better management of patients, but it also determines the need of a deeper comprehension of pathophysiology and the analysis of local expertise in order to develop a rational management algorithm. Obscure gastrointestinal bleeding can be divided in occult, when a positive occult blood fecal test is the main manifestation, and overt, when external sings of bleeding are visible. In this paper we are going to focus on overt gastrointestinal bleeding, describing the physiopathology of the most usual causes, analyzing the diagnostic procedures available, from the most classical to the novel ones, and establishing a standard algorithm which can be adapted depending on the local expertise or availability. Finally, we will review the main therapeutic options for this complex and not so uncommon clinical problem.
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Hybrid endolaparoscopic management of biliary tract pathology in bariatric patients after gastric bypass: case report and review of a single-institution experience. Surg Laparosc Endosc Percutan Tech 2013; 23:e188-90. [PMID: 24105293 DOI: 10.1097/sle.0b013e31828b85e8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Obesity is the major risk factor in cholesterol crystal and gallstone formation. After an Roux-en-Y gastric bypass, biliary duct dilatation can appear and gallstone formation can cause biliary duct obstruction or gallstone pancreatitis. Management of this clinical situation can be challenging and many approaches have been reported. Endoscopic retrograde cholangiopancreatography plays an important role in the management of biliary duct obstruction in these patients. However, a previous modified anatomy makes this procedure technically difficult. For these reason, we describe our single-institution experience in the management of biliary duct obstruction utilizing a hybrid approach combining laparoscopy and flexible endoscopy.
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Unexpected changes in the gastric remnant in asymptomatic patients after Roux-en-Y gastric bypass on vertical banded gastroplasty. Obes Surg 2013; 23:131-9. [PMID: 23129236 DOI: 10.1007/s11695-012-0808-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The aims of this study are to evaluate the macroscopic and microscopic changes in the remnant stomach at mid-term follow-up of patients who underwent a Roux-en-Y gastric bypass on vertical banded gastroplasty (RYGB-on-VBG). The stomach could be reached through a 1.1-cm gastro-gastrostomy with an endoscope of standard size. METHODS From January 2009 to July 2010, 51 asymptomatic patients at 4 and 5 years follow-up after RYGB-on-VBG submitted to upper endoscopy. All of them were examined with standard endoscopy with collection of biopsies in gastric fundus, body, and antrum. The macroscopic and microscopic findings were analyzed according to Sydney Classification. RESULTS The endoscopy of the remnant stomach was technically easy and already showed on macroscopic examination 90 % cases of gastritis (41.2 % mild, 49 % severe) with tendency of severity in the distal stomach part. Histological analysis detected 39.2 % of active gastritis, 50.6 % of quiescent gastritis, 7.8 % of intestinal metaplasia, and 3.9 % of lymphoma-like gastritis. CONCLUSIONS The results surprised us. We found a very high rate of mucosa abnormalities after RYGB-on-VBG. All of the patients have to be regularly controlled in follow-up and treatment has to be introduced when needed. Again, we would like to ask the question: what is happening with the remnant stomach after standard RYGB, banded gastric bapass, or minigastric bypass? Did we reach the time to answer the question?
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Abstract
BACKGROUND Obesity is associated with several comorbidities like diabetes, hypertension, hyperlipidemia, and obstructive sleep apnea. It is also well established that obese patients have an increased risk of several types of cancer like kidney, pancreas, endometrial, breast, and others. The bariatric surgeon needs to be aware of the problem of benign tumors and cancer in obese patients as well as the optimal management of these conditions that may be present at the time of evaluation for bariatric surgery, during the surgical procedure, and in the postoperative period. DATABASE A PubMed search for the words "cancer" and "bariatric surgery" and subsequent review of the abstracts identified 40 articles concerning cancerous, benign, and premalignant conditions in bariatric surgery patients. Data were then extracted from full-text articles. CONCLUSION Bariatric surgery decreases cancer risk especially in women. RYGB can be an effective treatment for Barrett's esophagus. Patients having esophageal cancer should not undergo bariatric surgery, while those who develop the same postoperatively are usually managed by a combined abdominal and thoracic approach (Ivor Lewis technique). Gastric cancer of the remnant stomach is usually managed by a remnant gastrectomy. A remnant gastrectomy during RYGB would be necessary in conditions that require endoscopic surveillance of the stomach like gastric polyps, intestinal metaplasia, and carcinoid tumors. Sleeve gastrectomy is an excellent option in a patient with GIST or a carcinoid who needs a bariatric operation. Preoperative endoscopy usually does not detect malignant conditions. Postoperative evaluation of the bypassed stomach is possible using various percutaneous and novel endoscopic techniques.
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Affiliation(s)
- Rao S Raghavendra
- Division of Metabolic Endocrine and Minimally Invasive Surgery, Mount Sinai Medical Center, NY, New York, USA.
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Laparoscopic Transgastric Endoscopy after Roux-en-Y Gastric Bypass: Case Series and Review of the Literature. Am Surg 2012. [DOI: 10.1177/000313481207801037] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Endoscopic access to the gastric remnant and pancreatobiliary tree is technically difficult after Roux-en-Y gastric bypass even when facilitated by the use of specialized techniques such as balloon enteroscopy and the use of overtubes. Furthermore, such techniques are not universally available at all medical centers. We describe a case series of 13 patients with a history of Roux-en-Y gastric bypass for the treatment of morbid obesity who underwent laparoscopic transgastric endoscopy through the gastric remnant to access the duodenum or biliary tree. Charts of these patients were reviewed for demographics, indications for procedure, length of stay, morbidity, and mortality. Four of the patients had failed prior attempts to access the excluded anatomy through traditional transoral endoscopy. Two patients underwent transgastric endoscopy for evaluation of gastrointestinal bleeding. Of the 11 patients for whom endoscopic retrograde cholangiopancreatography was planned, all underwent successful biliary cannulation and sphincterotomy. There were no conversions to an open procedure or complications during the follow-up period. Laparoscopic transgastric endoscopy is a safe and reliable method to access the excluded stomach and biliary tree in patients with a history of Roux-en-Y gastric bypass.
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Abstract
Endoscopy is a minimally invasive procedure using instruments that pass through the body for diagnostic purposes and minimizes the risks associated with open surgery. Colonoscopy can viewed as an endoscopic procedure of the colon. Colonoscopy may cause extreme discomfort to the patient and also carries the risks of perforating the lining of the colon, splenic ruptures, or bleeding. The technology is an endoscope that has an exoskeleton structure of controllable stiffness and a highly flexible stem. The device saves the patient from the pain caused by the shaft of a colonoscope when it is guided from the anus to the end of the sigmoid colon. The stiffenable sheath guides the shaft of the colonoscope up to the end of the sigmoid colon to avoid looping the shaft of the colonoscope. A prototype of the device was built and tested to validate its effectiveness. In order to further improve the performance of the device, skilled endoscopists tested and validated the device using a colonoscopy training model. The colonoscopy training model is comprised of a configurable rubber colon, a human torso, a display, and sensing part. It measures the forces caused by the distal tip and the shaft of the colonoscope and the pressure to open up the lumen. The force sensors at the rubber colon constraints measure the forces, and the real-time display panel will show the results to the colonoscopist and record the data for analysis. The endoscopy sheath device improves the process of endoscopy by reducing the mechanical trauma and loops caused by the shaft of the endoscope. With the guide provided by the colonoscope sheath, the forces to the constraints of a colon are significantly decreased in the sigmoid colon. The colonoscope sheath helps to reduce the force to constraints of the colon and isolates the direct contact between the shaft of a colonoscope and a colon wall up to the end of the sigmoid colon. For the complicated shape of the colon, the endoscopy sheath also solved possible looping problems. The colonoscope training model effectively measures the forces and makes it possible to validate the effectiveness of the endoscopy sheath.
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Affiliation(s)
- JungHun Choi
- 254 Stocker Center, Department of Mechanical Engineering, Ohio University, Athens, OH 45701 e-mail:
| | - David Drozek
- Department of Specialty Medicine, College of Osteopathic Medicine, Ohio University, Athens, OH 45701 e-mail:
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Greenstein AJ, O'Rourke RW. Abdominal pain after gastric bypass: suspects and solutions. Am J Surg 2011; 201:819-27. [PMID: 21333269 DOI: 10.1016/j.amjsurg.2010.05.007] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2009] [Revised: 05/21/2010] [Accepted: 05/21/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND Gastric bypass remains the mainstay of surgical therapy for obesity. Abdominal pain after gastric bypass is common and accounts for up to half of all postoperative complaints and emergency room visits. This article reviews the most important causes of abdominal pain specific to gastric bypass and discusses management considerations. METHODS The current surgical literature was reviewed using PubMed, with a focus on abdominal pain after gastric bypass and the known pathologies that underlie its pathogenesis. RESULTS The etiologies of abdominal pain after gastric bypass are diverse. A thorough understanding of their pathogenesis impacts favorably on clinical outcomes. CONCLUSIONS The differential diagnosis for abdominal pain after gastric bypass is large and includes benign and life-threatening entities. Its diverse causes require a broad evaluation that should be directed by history and clinical presentation. In the absence of a clear diagnosis, the threshold for surgical exploration in patients with abdominal pain after gastric bypass should be low.
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Affiliation(s)
- Alexander J Greenstein
- Department of Surgery, Oregon Health and Science University, Portland, OR 97239-3098, USA
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Azagury DE, Lautz DB. Endoscopic techniques in bariatric patients: Obesity basics and normal postbariatric surgery anatomy. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2010. [DOI: 10.1016/j.tgie.2010.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Wang AY, Sauer BG, Behm BW, Ramanath M, Cox DG, Ellen KL, Shami VM, Kahaleh M. Single-balloon enteroscopy effectively enables diagnostic and therapeutic retrograde cholangiography in patients with surgically altered anatomy. Gastrointest Endosc 2010; 71:641-9. [PMID: 20189529 DOI: 10.1016/j.gie.2009.10.051] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Accepted: 10/30/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND In patients with surgically altered anatomy, ERCP is often unsuccessful. Single-balloon enteroscopy (SBE) enables deep intubation of the small bowel, permitting diagnostic and therapeutic ERCP in this subset of patients. OBJECTIVE To determine the effectiveness of SBE in performing endoscopic retrograde cholangiography (ERC) in patients with surgically altered anatomy. DESIGN Case series. SETTING Large quaternary-care center. PATIENTS Thirteen patients (11 women) underwent 16 SBE procedures with ERCP. Patient anatomy consisted of Whipple (n = 3), hepaticojejunostomy (n = 3), Billroth II (n = 1), and Roux-en-Y (n = 9). INTERVENTIONS Patients with surgically altered anatomy in whom standard ERCP techniques had failed or were not possible underwent ERC by using SBE with initial therapeutic intent. MAIN OUTCOME MEASUREMENTS Success rates of diagnostic ERC and therapeutic ERC in those patients who required biliary intervention. Procedure-related complications were also assessed. RESULTS Diagnostic ERC was successful 12 (92.3%) of 13 patients and in 13 (81.3%) of 16 cases. Therapeutic ERC was required in 10 patients in whom diagnostic ERC was first accomplished, and therapeutic ERC was successful in 9 (90%) of 10 patients. Biliary interventions included balloon dilation (n = 4), stone extraction (n = 2), sphincterotomy (n = 4), removal of a surgically placed stent (n = 3), and stenting (n = 2). Two patients developed pancreatitis after therapeutic ERC. Median follow-up was 53 days (range 22-522 days). Overall procedural success in an intent-to-treat analysis by case was 75%. LIMITATION Single-center experience. CONCLUSION SBE enables diagnostic and therapeutic ERC in most patients with altered anatomy. SBE-assisted therapeutic ERC may be associated with an increased risk of pancreatitis. Improvement of the available equipment is necessary to perform more efficient and effective biliary interventions.
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Affiliation(s)
- Andrew Y Wang
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia 22908, USA
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Endoscopy after bariatric surgery (with videos). Gastrointest Endosc 2009; 70:1161-6. [PMID: 19647249 DOI: 10.1016/j.gie.2009.03.1168] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Accepted: 03/22/2009] [Indexed: 02/08/2023]
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Tierney WM, Adler DG, Conway JD, Diehl DL, Farraye FA, Kantsevoy SV, Kaul V, Kethu SR, Kwon RS, Mamula P, Pedrosa MC, Rodriguez SA. Overtube use in gastrointestinal endoscopy. Gastrointest Endosc 2009; 70:828-34. [PMID: 19703691 DOI: 10.1016/j.gie.2009.06.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Accepted: 06/12/2009] [Indexed: 02/08/2023]
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Huang CS. The role of the endoscopist in a multidisciplinary obesity center. Gastrointest Endosc 2009; 70:763-7. [PMID: 19555946 DOI: 10.1016/j.gie.2009.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Accepted: 01/12/2009] [Indexed: 12/16/2022]
Affiliation(s)
- Christopher S Huang
- Section of Gastroenterology, Boston Medical Center, Boston University School of Medicine, 85 E Concord St, no. 7714, Boston, MA 02118, USA
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Dellon ES, Kohn GP, Morgan DR, Grimm IS. Endoscopic retrograde cholangiopancreatography with single-balloon enteroscopy is feasible in patients with a prior Roux-en-Y anastomosis. Dig Dis Sci 2009; 54:1798-803. [PMID: 18989776 DOI: 10.1007/s10620-008-0538-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Accepted: 09/11/2008] [Indexed: 12/11/2022]
Abstract
The purpose of this study is to describe the feasibility of using single-balloon enteroscopy (SBE) to perform endoscopic retrograde cholangiopancreatography (ERCP) in patients who had a prior Roux-en-Y (RY) anastomosis. This case series describes four patients, one with RY gastric bypass, two with RY due to bile duct injury, and one with RY after liver transplantation, who underwent ERCP with SBE. Cholangiography was successful in three of the four patients. In the procedure that was not successful, the enteroenterostomy site could not be located. The successful procedures ranged from 65-91 min in duration. Medication doses were higher than with typical ERCPs. No procedural complications occurred. SBE for ERCP is a feasible option for endoscopic access to the biliary tree in patients with prior RY anastomoses. Limitations of this technique include the time requirement, delay in identification of the enteroenterostomy site, potential learning curve, and immature technology lacking accessories.
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Affiliation(s)
- Evan S Dellon
- Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, 130 Mason Farm Rd., Chapel Hill, NC 27599-7080, USA.
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Morgan KA, Fontenot BB, Ruddy JM, Mickey S, Adams DB. Endoscopic Retrograde Cholangiopancreatography Gut Perforations: When to Wait! When to Operate! Am Surg 2009. [DOI: 10.1177/000313480907500605] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Most perforations of the gastrointestinal tract during endoscopic retrograde cholangiopancreatography (ERCP) can be managed nonoperatively. Identifying patients who require operative management is problematic. A clinical endoscopy database was queried for patients who sustained ERCP perforation over a 13-year period. Records were reviewed and analyzed with approval of the Institutional Review Board. During the study period, 12,817 patients underwent ERCP; 24 (0.2%) had an endoscopic perforation. Twelve patients had a retroperitoneal perforation during sphincterotomy and all were successfully managed nonoperatively. Nine of these were undergoing treatment for sphincter of Oddi dysfunction. Twelve patients had perforation remote from the papilla. Of these, 10 required surgical intervention. Six patients had surgically altered anatomy (three postpancreaticoduodenectomy, three post-Billroth II gastrectomy) and one had situs inversus. Six of these seven required surgical intervention. Median length of stay of all patients was 7.5 days, morbidity was 25 per cent, and one patient died 16 days after surgery. Gut perforation after ERCP requires prompt surgical evaluation. Patients with sphincterotomy-related retroperitoneal perforation can be managed safely with nonoperative therapy in most instances. Patients with remote perforation usually need surgical intervention. Altered foregut anatomy leads to injuries that usually require operative management.
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Affiliation(s)
- Katherine A. Morgan
- Section of Gastrointestinal and Laparoscopic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Bennett B. Fontenot
- Section of Gastrointestinal and Laparoscopic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Jean M. Ruddy
- Section of Gastrointestinal and Laparoscopic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Suzanne Mickey
- Section of Gastrointestinal and Laparoscopic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - David B. Adams
- Section of Gastrointestinal and Laparoscopic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
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Morgan KA, Glenn JB, Byrne TK, Adams DB. Sphincter of Oddi dysfunction after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2009; 5:571-5. [PMID: 19356993 DOI: 10.1016/j.soard.2008.12.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Revised: 12/18/2008] [Accepted: 12/29/2008] [Indexed: 01/27/2023]
Abstract
BACKGROUND Patients who have undergone Roux-en-Y gastric bypass for morbid obesity may develop postoperative abdominal pain disorders that require surgical evaluation. Chronic pancreatitis and pain associated with sphincter of Oddi dysfunction (SOD) is an uncommon disorder whose clinical diagnosis is problematic without sphincter of Oddi manometry. To evaluate the diagnosis and treatment of SOD in the gastric bypass population, a retrospective review and analysis of gastric bypass patients who had undergone transduodenal sphincteroplasty (TS) for SOD was undertaken. METHODS The medical records of patients who had undergone TS after gastric bypass at the Medical University of South Carolina Digestive Disease Center from January 2002 to December 2006 were evaluated for outcomes-based data with the approval of the institutional review board for the evaluation of human subjects. Long-term patient outcomes were assessed using the Medical Outcomes Study Short Form 36-item, version 2, quality-of-life survey. RESULTS A total of 16 women (median age 49 years) were identified who had undergone TS with biliary sphincteroplasty and pancreatic ductal septoplasty for SOD. The indications for surgery included pain (100%), nausea (31%), weight loss (13%), and recurrent pancreatitis (31%). The diagnosis of SOD was supported by magnetic resonance cholangiopancreatography with secretin stimulation. Three postoperative complications (18.8%) developed, but no mortality. The average length of hospital stay was 5 days (range 2-9). Of the 16 patients, 13 (81%) responded to the survey follow-up. The mean length of follow-up was 28 months (range 16-57). Of the 13 patients, 11 (85%) reported pain improvement after surgery. The survey's norm-based scores were similar to those of a representative population. CONCLUSION SOD should be considered in the differential diagnosis of gastric bypass patients with pancreatobiliary pain after cholecystectomy. When the clinical history is supported by laboratory and magnetic resonance cholangiopancreatography data, TS can be undertaken with low morbidity and good patient outcomes. SOD is a notable disorder in the gastric bypass population. With appropriate patient selection, TS can be beneficial.
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Affiliation(s)
- Katherine A Morgan
- Section of Gastrointestinal and Laparoscopic Surgery, Medical University of South Carolina, Charleston, SC 29425, USA.
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Anderson MA, Gan SI, Fanelli RD, Baron TH, Banerjee S, Cash BD, Dominitz JA, Harrison ME, Ikenberry SO, Jagannath SB, Lichtenstein DR, Shen B, Lee KK, Van Guilder T, Stewart LE. Role of endoscopy in the bariatric surgery patient. Gastrointest Endosc 2008; 68:1-10. [PMID: 18577471 DOI: 10.1016/j.gie.2008.01.028] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Accepted: 01/16/2008] [Indexed: 12/13/2022]
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Retrograde endoscopic cystgastrostomy for pancreatic pseudocyst drainage after a Prior Roux-en-Y gastric bypass. Obes Surg 2008; 19:243-246. [PMID: 18581190 DOI: 10.1007/s11695-008-9611-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Accepted: 06/02/2008] [Indexed: 10/21/2022]
Abstract
A 47-year-old woman with a history of Roux-en-Y gastric bypass developed a pancreatic pseudocyst after an episode of acute necrotizing pancreatitis. She presented with intractable abdominal pain and weight loss. Computed tomography scan revealed an enlarging pancreatic fluid collection abutting the gastric antrum. The patient underwent exploratory laparotomy, at which a Whipple procedure was aborted due to severe fibrosis and necrosis of her pancreas. Retrograde peroral endoscopic pancreatic pseudocyst drainage was successfully performed through the defunctionalized stomach.
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Management of choledocholithiasis after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2008; 4:674-8. [PMID: 18539541 DOI: 10.1016/j.soard.2008.01.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Revised: 12/05/2007] [Accepted: 01/09/2008] [Indexed: 11/23/2022]
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