Experience of endoscopic retrograde cholangiopancreatography with side-viewing duodenoscope in patients with previous gastric surgery/Mide ameliyati geçiren hastalarda yandan görüslü duedoskopi ile endoskopik retrograd kolanjiyopankreatografi deneyimimiz

• Published in: Turkish Journal of Surgery Vol. 38; no. 2; p. 149
• Main Authors: Gurbuz, Mehmet Emin, Karakas, Dursun Ozgur
• Format: Journal Article
• Language: English
• Published: AVES 01.06.2022
• Subjects: Complications; Complications and side effects; Endoscopic retrograde cholangiopancreatography; Gastrointestinal system; Methods; Physiological aspects; Surgery; Turkey
• ISSN: 2564-6850
• DOI: 10.47717/turkjsurg.2022.5490

Objective: Endoscopic Retrograde Cholangiopancreatography (ERCP) with conventional side-viewing duodenoscope can be challenging and unsuccessful at altered anatomy in the gastrointestinal tract. This study aimed to evaluate our experience with ERCP in patients with previous gastric surgery. Material and Methods: Patients on whom ERCP was performed from January 2017 to August 2021 and who had previous gastric surgery were included into the study. Age, sex, comorbidity, Charlson's Comorbidity Index (CCI), ERCP indication, previous gastric surgery (indication, type of resection and reconstruction), history of cholecystectomy, and MRCP results were evaluated retrospectively. The results were compared as successful ERCP (SERCP) or unsuccessful ERCP (USERCP). Also, odds ratio ERCP failure was also evaluated. Results: Forty-three patients were included into study. Mean age was 68.8 [+ or -] 13.6 years. The most common sex was female (51.2%). The most common ERCP indication was choledocholithiasis with 44.2%, gastric surgery indication was peptic ulcer with 72.1%, gastric resection was subtotal with 67.4%, and reconstruction was gastrojejunostomy with 58.1%. The success rate of ERCP was 44.2%. Mean CCI was 4.16 [+ or -] 2.28. Only malignancy history was significantly higher in the USERCP group (p= 0.026). Male sex, non-choledocholithiasis indication, history of malignancy, CCI> 4, total gastrectomy, Roux-NY (RNY) reconstruction, history of cholecystectomy, and intercalarily to the bile duct dilatation in MRCP were likelihood for USERCP. Conclusion: While history of malignancy and cholecystectomy were the only significant factor for unsuccessful ERCP, male sex, total gastrectomy, RNY anastomosis result in a higher likelihood of ERCP failure in patients with previous gastric surgery. Alternative devices to side-viewing duodenoscope will increase success in selected patients. Keywords: Endoscopic retrograde cholangiopancreatography, gastrectomy, roux ny, gastrojejunostomy Giris ve Amaç: Gastrointestinal sistem anatomisi degisenlerde konvansiyonel yandan görüslü duedonoskop ile endoskopik retrograf kolanjiyopankreatografi (ERCP) zor ve basarisiz olabilmektedir. Mide ameliyati geçiren hastalarda ERCP deneyimimizi degerlendirmeyi amaçladik. Gereç ve Yöntem: Ocak 2017' den Agustos 2021 tarihleri arasinda ERCP yapilmis mide cerrahisi geçirmis hastalar çalismaya dahil edildi. Hastalarin yas, cinsiyet, komorbidite, Charlson Komorbidite Indeksi (CCI), ERCP endikasyonu, geçirilmis mide cerrahisi (endikasyonu, mide rezeksiyon ve rekonstrüksiyon sekli), kolesistektomi öyküsü, MRCP sonuçlari geriye dönük degerlendirildi. Sonuçlar basarili (SERCP) veya basarisiz (USERCP) olmasina göre de karsilastirildi. Ayrica ERCP basarisizliginin Odds oranlari degerlendirildi. Bulgular: Kirk üç hasta çalismaya dahil edildi. Ortalama yas 68,8 [+ or -] 13,6 idi. En sik görülen cinsiyet kadindi (%51,2). En sik ERCP endikasyonu %44,2 ile koledokolitiazis, mide cerrahisi endikasyonu %72,1 ile peptik ülser, %67,4 ile subtotal mide rezeksiyonu ve %58,1 ile gastrojejunostomi rekons-trüksiyonu idi. Endoskopik retrograd kolanjiopankreatografinin basari orani %44,2 idi. Ortalama CCI 4,16 [+ or -] 2,28 idi. USERCP grubunda sadece malignite öyküsü anlamli derecede yüksekti (p= 0,026). Erkek cinsiyet, koledokolitiazis disi endikasyon, malignite öyküsü, CCI> 4, total gastrektomi, roux ny (RNY) rekonstrüksiyonu, kolesistektomi öyküsü, MRCP'de safra kanali dilatasyonuna ek olarak bulgu olanlarda USERCP olasiligi daha yüksek saptandi. Sonuç: Malignite ve kolesistektomi öyküsü, basarisiz ERCP için tek anlamli faktörler iken, erkek cinsiyet, total gastrektomi, RNY anastomozu, daha önce mide ameliyati geçirmis hastalarda basarisiz ERCP olasiligi daha yüksek olmaktadir. Seçilmis hastalarda yandan görüslü duodenoskopa alternatif cihazlar basari orani artacaktir. Anahtar Kelimeler: Endoskopik retrograd kolanjiyopankreatografi, gastrektomi, roux ny, gastrojejunostomi