Complications rate of surgically assisted endoscopic retrograde cholangiopancreatography

Abstract

Background: With the rise in obesity and gastric bypass procedures, the normal anatomy and approach for endoscopic retrograde cholangiopancreatography (ERCP) is eliminated. Surgically assisted ERCP is the standard technique to access the biliary system and perform ERCP in these patients. These patients are at increased risk for cholelithiasis. As such, the need for surgically assisted ERCP has increased in patients when transoral access to the biliary tree is not possible. To date, there are little data reporting complications and outcomes of this procedure. We aimed to perform a retrospective cohort study to identify demographic, clinical and outcomes data to ascertain significant complications and complications rates of surgically assisted ERCP. Materials and Methods: We conducted a retrospective review of electronic health record data of patients who underwent surgically assisted ERCP at three hospitals over a 10-year period, between April 2010 and July 2020, and identified 53 patient encounters for 50 unique patients. Results: Fifty patients who underwent 53 surgically assisted ERCP were identified during the study period. Twenty-two (41.5%) of those patients had a complication. Conversion from laparoscopic to open procedure occurred in 10 cases. The overall complication rate was 44% with most complications (91%) related to surgical access as opposed to ERCP (9%). Conclusions: Surgically assisted ERCP is associated with significant risks for complications primarily due to surgical access. Further studies need to be conducted to compare the risks of surgically assisted ERCP to other approaches for biliary access in the post-bariatric surgery population.

Keywords

• Bariatric surgery
• Choledocholithiasis
• Surgically assisted ERCP
• Laparoscopic assisted ERCP