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ERCP in Post-Surgical Patients

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ERCP and EUS

Abstract

Pancreatobiliary problems in patients with altered gastrointestinal anatomy present a special challenge. The difficulties are distributed across all the relevant clinical domains including diagnosis, endoluminal access (as a result of the altered length), technical modifications of the procedure and aftercare. Indications for endoscopic retrograde cholangiopancreatography (ERCP) in patients who are post-surgical encompass all the indications for the procedure in patients with native gastrointestinal anatomy. Some conditions are more common in patients who have undergone weight loss surgery. Rapid weight loss increases bile lithogenicity and thus the likelihood of gallstone formation in those patients with intact gallbladders.

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Author information

Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, Johns Hopkins University School of Medicine, 5721 Benton Heights Ave., Baltimore, MD 21206, USA

    Jemilat O. Badamas MD,

  2. Department of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Suite 7-225, 1800 North Orleans St, Baltimore, MD 21287, USA

    III Patrick I. Okolo MD, MPH

Authors
  1. Jemilat O. Badamas MD,
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  2. III Patrick I. Okolo MD, MPH
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Corresponding author

Correspondence to Patrick I. Okolo MD, MPH .

Editor information

Editors and Affiliations

  1. Gastroenterology, Hepatology, and Endoscopy, Brigham and Women’s Hospital, Boston, Massachusetts, USA

    Linda S. Lee

Electronic supplementary material

Video Caption

Video 17.1 The patient in this video had undergone a laparoscopic cholecystectomy complicated by biliary injury requiring Roux-en-Y hepaticojejunostomy. Many years later, she presented with biliary colic and elevated LFTs. MRCP demonstrated biliary stones with mild narrowing of the distal bile duct and anastomosis. This video demonstrates device-assisted enteroscopy using single-balloon enteroscopy to navigate across the jejuno-jejunal anastomosis and then to the hepaticojejunostomy where migrated suture material is visible emerging from the bile duct with a bland appearance of the mucosa surrounding the anastomosis. Cholangiogram (not shown here) showed mild distal biliary/anastomotic deformity and narrowing. Balloon dilation of the distal bile duct and anastomosis was performed using a hydrostatic balloon over a long guidewire. Note subsequent direct endoscopic visualization of stones followed by balloon extraction of the stones. Subsequent to the video, the migrated suture was removed using argon plasma coagulation

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Badamas, J., Okolo, P. (2015). ERCP in Post-Surgical Patients. In: Lee, L. (eds) ERCP and EUS. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2320-5_17

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  • DOI: https://doi.org/10.1007/978-1-4939-2320-5_17

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-2319-9

  • Online ISBN: 978-1-4939-2320-5

  • eBook Packages: MedicineMedicine (R0)

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