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首页> 外文期刊>Surgical Endoscopy >Laparoscopic transgastric endoscopic retrograde cholangiopancreatography (ERCP) after gastric bypass: case series and a description of technique.
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Laparoscopic transgastric endoscopic retrograde cholangiopancreatography (ERCP) after gastric bypass: case series and a description of technique.

机译：胃搭桥术后经腹腔镜胃内镜逆行胰胆管造影（ERCP）：病例系列及技术描述。

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BACKGROUND: Roux-en-Y gastric bypass excludes the biliary and pancreatic tree from traditional endoscopic evaluation and treatment. As the number of former bypass patients accrues, the need to assess and treat this subset of patients for biliary and pancreatic disease will increase. The authors describe their technique, indications, and outcomes for this group of patients. METHODS: Data were collected by a retrospective chart review of the experience two surgeons had with laparoscopically assisted transgastric endoscopic retrograde cholangiopancreatography (ERCP) from July 2004 to October 2008 at a single institution. This review identified 22 cases. The operating surgeon performed the entire procedure. The indications were suspected sphincter of Oddi dysfunction in 18 patients and recurrent pancreatitis in four patients. Adhesions were lysed, and a purse-string suture was placed on the anterior portion of the stomach. A gastrotomy was made with monopolar electrocautery, and a 12 mm trocar was inserted. It was secured with a purse-string suture. A side-viewing duodenoscope was inserted through this port. An intestinal clamp was placed on the biliopancreatic limb. The intended interventions were sphincter of Oddi manometry, sphincterotomy, placement of a pancreatic duct stent, and injection of botulinum toxin if indicated. RESULTS: Laparoscopic access to the remnant stomach was sufficient for ERCP in 21 cases. One patient required conversion to an open procedure. A total of 12 patients had undergone prior open upper abdominal surgery. One retroperitoneal perforation was noted, with precut sphincterotomy and cannulation of the minor duodenal papilla and no clinical repercussions. Manometry was performed for 18 patients. The pancreatic duct cannulation rate for manometry was 89%, and the rate of bile duct cannulation for manometry was 94%. The manometry studies for 12 patients yielded abnormal results. Eight patients had transient improvement, and three patients had long-term improvement or resolution of symptoms after the index procedure. With additional treatment, two of the transient responders had long-term resolution of symptoms. CONCLUSIONS: The findings demonstrate that gastric bypass patients with biliary pain can be successfully evaluated endoscopically by laparoscopic transgastric ERCP for sphincter of Oddi dysfunction. The rate for technical success and complications does not appear to be significantly greater than for standard ERCP. A few helpful techniques were noted during this experience. Comparison of efficacy with that of a prior study was limited.
机译：背景：Roux-en-Y胃旁路术将胆道和胰树排除在传统的内镜评估和治疗之外。随着以前旁路手术患者的增加，评估和治疗这一部分患者的胆道和胰腺疾病的需求将会增加。作者描述了这组患者的技术，适应症和结局。方法：通过回顾性图表回顾的方式收集数据，该回顾性回顾了2004年7月至2008年10月在单个机构进行的腹腔镜辅助经胃内镜逆行胰胆管造影术（ERCP）的两位外科医生的经验。这项审查确定了22例。手术外科医生执行了整个过程。适应症包括疑似Oddi括约肌功能障碍18例和复发性胰腺炎4例。裂解粘连，并在胃的前部放置荷包缝线。用单极电烙术进行胃切开术，并插入12 mm的套管针。用荷包线缝合固定。通过该端口插入了一个十二指肠镜。将肠钳夹在胆胰四肢上。预期的干预措施包括Oddi括约肌测压，括约肌切开术，放置胰管支架以及注射肉毒杆菌毒素（如果有提示）。结果：21例腹腔镜通入残余胃足以进行ERCP。一名患者需要转换为开放式手术。共有12例患者曾接受过开放性上腹部手术。注意到腹膜后穿孔，预切括约肌切开术和小十二指肠乳头的插管术，无临床影响。对18位患者进行了测压。测压的胰管插管率为89％，测压的胆管插管率为94％。对12位患者的测压研究结果异常。索引程序后，有8例患者暂时改善，有3例患者长期改善或症状缓解。通过额外的治疗，两名短暂反应者可长期缓解症状。结论：研究结果表明，腹腔镜经胃胃ERCP能成功评估胃旁路术胆汁痛患者的Oddi括约肌功能。技术成功率和并发症发生率似乎并不比标准ERCP大得多。在这次体验中，我们注意到了一些有用的技术。与先前研究的疗效比较有限。

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