Mo1458 The Incidence of Post ERCP Pancreatitis, Bleeding, Perforation and ERCP Related Mortality, and Clinical Risk Factors for Post ERCP Pancreatitis: a Population Based Study

Abstract

Surgical Gastrostomy to Access the Bypassed Stomach: Same Day or Delayed ERCP? Carlos R. Gonzalez*, James L. Watkins, Lee Mchenry, Evan L. Fogel, Glen A. Lehman, Nicholas J. Zyromski Surgery, IU school of medicine, Indianapolis, IN; Gastroenterology, Indiana University Hospital, Indianapolis, IN Background: Endoscopic access to the pancreatobiliary system following Rouxen-Y gastric bypass is challenging. Double balloon enteroscopy can be performed, however cannulation of the native papilla is suboptimal. ERCP via the gastric remnant is preferred but requires surgical gastrostomy placement into the gastric remnant. This analysis compared patients having same day (SD-ERCP) versus delayed (D-ERCP) endoscopic retrograde cholangiopancreatography following surgical access to the gastric remnant. Methods: 24 consecutive patients requiring open surgical gastrostomy into the gastric remnant were analyzed: 13 patients had SD-ERCP and 11 had D-ERCP. Demographic and clinical data were compared. Appropriate statistics were applied; p 0.05 was considered statistically significant. Results: The majority of patients were female (96%) and Caucasian (83%). The median age was 47 years (range 30 to 60). ERCP indications included suspected sphincter of Oddi dysfunction vs chronic pancreatitis (83%); cholangitis, common bile duct stricture, bile leak, and retained bile duct stent (4% each). In D-ERCP group, ERCP was performed 41 / 4 days after gastrostomy. The duration of gastrostomy tube maintenance was 42 / 3 days in SD-ERCP compared to 51 / 4 days in D-ERCP (p 0.02). Following surgical gastrostomy, hospital length of stay was 5 / 1 days in SD-ERCP and 5 / 1 days in D-ERCP (p 0.88). Two patients (8%) developed superficial surgical site infection (SD-ERCP 1, D-ERCP 1), one was severe. One patient (4%) in the D-ERCP group developed delayed abdominal wall hematoma. Successful ERCP was achieved in 23 patients (96%). No mortality occurred in either group. Conclusions: After gastrostomy placement in the gastric remnant, same day ERCP decreased length of time required for gastrostomy tube maintenance compared to delayed ERCP. Similar perioperative outcomes, (including a similar minor complication profile) were observed in both same day and delayed ERCP groups. In the bypassed stomach, same day ERCP after surgical gastrostomy provides safe and practical access to the pancreatobiliary system.