Endoscopic retrograde cholangiopancreatography in patients with different types of total and partial gastrectomy.

IF 1.2 4区医学 Q4 GASTROENTEROLOGY & HEPATOLOGY

Acta gastro-enterologica Belgica Pub Date : 2025-01-01 DOI:10.51821/88.1.13779

F Fortunati, L Monino, P Deprez, H Piessevaux, T Moreels

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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.

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内镜逆行胰胆管造影在不同类型胃全、部分切除术患者中的应用。

背景和研究目的：内镜逆行胰胆管造影（ERCP）在手术解剖改变的患者中具有挑战性。我们分析了维持沃特氏乳头的胃手术后的ERCP方法：Roux-en-Y全胃/部分胃切除术、Billroth II胃切除术、袖胃切除术和胃空肠吻合术。方法：单中心回顾性分析2006年至2024年间手术改变胃解剖（SAGA）患者维持Vater's乳头的前瞻性ERCP队列。结果：186例ERCP手术110例SAGA患者的比例：37%全胃切除术Roux-en-Y， 32% Billroth II部分胃切除术，15%部分胃切除术Roux-en-Y， 11%胃空肠吻合术，4%袖胃切除术和1%较少见的重建。ERCP的适应症主要是胆道（87%）。Roux-en-Y胃手术的总技术成功率为82%，而Roux-en-Y胃手术的技术成功率为73%，而没有Rouxen- Y胃手术的技术成功率为92%。13例不良事件（II - IV级）发生（7%），1例因术中心脏骤停死亡。套筒胃切除术允许使用常规十二指肠镜，技术成功率为100%。在Billroth II型患者中，十二指肠镜、胃镜和结肠镜以及球囊辅助肠镜的技术成功率很高（94-100%），胃空肠吻合术患者的技术成功率也很高（57-100%）。对于Roux-en-Y重建，只有单球囊肠镜获得了可接受的成功（Roux-en-Y部分切除术75%，全胃切除术74%）。结论：SAGA患者的ERCP具有挑战性，需要不同类型的内窥镜，特别是Roux-en-Y全胃或部分胃切除术后，与Billroth II胃切除术、套筒胃切除术和胃空肠吻合术相比，技术成功率较低。不良事件发生率与正常解剖患者的ERCP手术相当。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta gastro-enterologica Belgica Medicine-Gastroenterology

CiteScore

2.30

自引率

20.00%

发文量

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.