Objective:

To evaluate the efficacy of Single Balloon Enteroscopy Assisted Endoscopic Retrograde Cholangiopancreatography (SBEA-ERCP) and Transgastric Laparoscopic-Assisted Endoscopic Retrograde Cholangiopancreatography (TGLA-ERCP) approaches in the treatment of biliary pathology in patients with Roux-Y gastric bypass.

Patients and methods:

Prospective study (February 2009- May 2015). 16 patients (20 procedures) with Roux-Y gastric bypass with a diagnosis of biliary pathology were included, 11 SBE-ERCP patients (46 ± 12 years), (5) TGLA-ERCP patients (50 ± 10 years). Diagnostic and therapeutic success rate, procedure time, complications, and hospital stay were evaluated.

Results:

20 procedures were performed (11 SBE-ERCP, 9 TGLA-ERCP). In 9 (81.81%) SBE-ERCP the papilla was identified and cannulated, diagnosing lithiasis (5), papilla tumor (1), Oddi dysfunction (1), stenosis (1). Therapy was performed in 9 patients: sphincterotomy (8), sphincteroplasty (1), stone extraction (5), biopsy (1), prosthesis placement (2), prosthesis removal (1). In 2 (18.2%) patients the procedure failed (it did not reach the papilla). In 9 (100%) TGLA-ERCP patients, the papilla was identified and cannulated, diagnosing: lithiasis (5), stenosis (1), Oddi dysfunction (2), papilla tumor (1), prosthesis (2). Therapeutic was performed in all of them: sphincterotomy (7), stone extraction (5), mechanical lithotripsy (1), prosthesis extraction (2), biopsy (1). Procedure time SBE-ERCP 86 ± 25 minutes / TGLA-ERCP 34 ± 6 minutes (p = 0.001). Hospital stay SBE-ERCP 44 ± 18 hours / TGLA-ERCP 136 ± 38 hours (p = 0.001). Complications: TGLA-ERCP: endoscopically resolved bleeding (1), hyperamylasemia (3).

Conclusions:

Our results suggest that both methods have similar diagnostic and therapeutic efficacy. TGLA-ERCP is less laborious and less prolonged, with a longer hospital stay.