ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP): ANALYSIS OF THE EFFECTIVENESS AND SAFETY OF THE PROCEDURE IN THE PATIENT WITH ROUX-EN-Y GASTRIC BYPASS

ABSTRACT Background: Obesity can be treated with bariatric surgery; but, excessive weight loss may lead to diseases of the bile duct such as cholelithiasis and choledocholithiasis. Endoscopic retrograde cholangiopancreatography is a diagnostic and therapeutic procedure for these conditions, and may be hampered by the anatomical changes after surgery. Aim: Report the efficacy and the safety of videolaparoscopy-assisted endoscopic retrograde cholangiopancreatography technique in patients after bariatric surgery with Roux-en-Y gastric bypass. Method: Retrospective study performed between 2007 and 2017. Data collected were: age, gender, surgical indication, length of hospital stay, etiological diagnosis, rate of therapeutic success, intra and postoperative complications. Results: Seven patients had choledocholithiasis confirmed by image exam, mainly in women. The interval between gastric bypass and endoscopic procedure ranged from 1 to 144 months. There were no intraoperative complications. The rate of duodenal papillary cannulation was 100%. Regarding complications, the majority of cases were related to gastrostomy, and rarely to endoscopic procedure. There were two postoperative complications, a case of chest-abdominal pain refractory to high doses of morphine on the same day of the procedure, and a laboratory diagnosis of acute pancreatitis after the procedure in an asymptomatic patient. The maximum hospital stay was four days. Conclusion: The experience with endoscopic retrograde cholangiopancreatography through laparoscopic gastrostomy is a safe and effective procedure, since most complications are related to the it and did not altered the sequence to perform the conventional cholangiopancreatography.

摘要
背景：肥胖可通过减重手术（bariatric surgery）治疗，但过度体重丢失可能引发胆管相关疾病，如胆石症（cholelithiasis）与胆总管结石症（choledocholithiasis）。内镜逆行胰胆管造影术（Endoscopic Retrograde Cholangiopancreatography, ERCP）是此类疾病的诊断与治疗手段，但术后解剖结构改变可能对该操作造成阻碍。
目的：报告腹腔镜辅助内镜逆行胰胆管造影术在接受Roux-en-Y胃旁路术（Roux-en-Y Gastric Bypass）的肥胖术后患者中的有效性与安全性。
方法：本研究为2007年至2017年间开展的回顾性研究，收集的研究数据包括患者年龄、性别、手术适应证、住院时长、病因学诊断、治疗成功率、术中及术后并发症发生情况。
结果：共7例患者经影像学检查确诊为胆总管结石症，其中以女性居多。胃旁路术至内镜操作的间隔时长为1~144个月。术中未发生并发症，十二指肠乳头插管成功率达100%。并发症方面，多数病例与胃造口操作相关，仅极少数与内镜操作有关。共出现2例术后并发症：1例于操作当日出现胸腹痛，经大剂量吗啡治疗无效；1例无症状患者于术后经实验室检查确诊为急性胰腺炎。最长住院时长为4天。
结论：经腹腔镜胃造口途径实施内镜逆行胰胆管造影术的临床经验表明，该操作安全有效。尽管多数并发症与该操作相关，但未对常规胰胆管造影术的实施流程造成负面影响。