Multicenter evaluation of the clinical utility of laparoscopy-assisted ERCP in patients with Roux-en-Y gastric bypass

Background and Aims The obesity epidemic has led to increased use of Roux-en-Y gastric bypass (RYGB). These patients have an increased incidence of pancreaticobiliary diseases yet standard ERCP is not possible due to surgically altered gastroduodenal anatomy. Laparoscopic-ERCP (LA-ERCP) has been proposed as an option but supporting data are derived from single center small case-series. Therefore, we conducted a large multicenter study to evaluate the feasibility, safety, and outcomes of LA-ERCP. Methods This is retrospective cohort study of adult patients with RYGB who underwent LA-ERCP in 34 centers. Data on demographics, indications, procedure success, and adverse events were collected. Procedure success was defined when all of the following were achieved: reaching the papilla, cannulating the desired duct and providing endoscopic therapy as clinically indicated. Results A total of 579 patients (median age 51, 84% women) were included. Indication for LA-ERCP was biliary in 89%, pancreatic in 8%, and both in 3%. Procedure success was achieved in 98%. Median total procedure time was 152 minutes (IQR 109-210) with median ERCP time 40 minutes (IQR 28-56). Median hospital stay was 2 days (IQR 1-3). Adverse events were 18% (laparoscopy-related 10%, ERCP-related 7%, both 1%) with the clear majority (92%) classified as mild/moderate whereas 8% were severe and 1 death occurred. Conclusion Our large multicenter study indicates that LA-ERCP in patients with RYGB is feasible with a high procedure success rate comparable with that of standard ERCP in patients with normal anatomy. ERCP-related adverse events rate is comparable with conventional ERCP, but the overall adverse event rate was higher due to the added laparoscopy-related events

The risk of esophageal adenocarcinoma associated with Barrett\u27s esophagus and gastroesophageal reflux disease: A retrospective cohort study in U.S. veterans

Patients with Barrett\u27s esophagus (BE) and gastroesophageal reflux disease (GERD) are at a higher risk of developing esophageal adenocarcinoma (EA). We examined this risk in two large national cohorts of patients with BE and GERD alone and provided risk ratios comparing the risk in both cohorts. This was a retrospective cohort study of US veterans with BE and GERD alone diagnosed between 2003 and 2009, identified from a total of 121 Veterans\u27 Affairs facilities nationwide. All cases of EA were verified by detailed medical chart review. We identified 29,536 with BE and 486,676 patients with GERD who met our eligibility criteria. Most patients in both cohorts were men and white, with a mean age of 59.8 and 61.8 years, respectively. The incidence rate of EA in patients with BE was 3.215 per 1,000 person-years, and 0.206 per 1,000 person-years in patients with GERD alone. The incidence of EA in patients with BE increased with age compared to patients with GERD alone. The highest risk of EA in patients with BE when compared to GERD alone was in blacks (incidence rate ratio 52.221, 95%CI 22.412-125.696). BE diagnosis significantly increased the risk of EA when compared to patients with GERD alone. This was most apparent in both black and elderly patients