P0858 - Are All Options Being Discussed in Patients With Choledocholithiasis and a History of Gastric Bypass?

Katherine Kendrick, MD¹, Mina Rismani, MD², Wesley Jones, MD¹, Veeral M. Oza, MD^1
1Prisma Health, Greenville, SC; ²Medical College of Georgia, Greenville, SC

Introduction: Roux-en-Y gastric bypass (RYGB) is currently one of the most common performed bariatric procedure and is an effective long term surgical therapy for treating obesity. The rapid weight loss that occurs with RYGB is a known risk factor for the development of biliary stone complications, with the incidence of post-RYGB cholelithiasis estimated to be around 37%. Given the challenge of accessing the ampulla in these patients, various procedures have been proposed, which include surgical (laparoscopic assisted ERCP (LA-ERCP)) and endoscopic ultrasound-directed transgastric ERCP (EDGE)). Although many studies have compared technical success as well as cost and morbidities between the two procedures, not many studies exist on how frequently are all the options presented to a patient. Ideally, when discussing informed consent, both options should be presented to patients. The aim of this small study was to evaluate how frequently are all options being presented to a RYGB patient needing an ERCP

Methods: A single hospital system electronic database was used to examine a case series of 17 adult patients with gastric bypass who underwent an ERCP and cholecystectomy. Data was analyzed as continuous (expressed as mean ± (standard deviation)) variables.

Results: Out of 17 patients, 29% of patients received LA-ERCP at the time of cholecystectomy. Twelve patients with a history of cholecystectomy had LA-ERCP, however only one of the 12 patients was offered EGDE, based on chart review

Discussion: In this single center experience, we found 29% of our patients underwent LA-ERCP with concominant cholecytectomy, as per protocol. However, only 1 of 12 (8%) patients who were eligible for EDGE were offered the procedure despite availability This points to the necessity of increased education of therapic options for choledocholithiasis in patients with history of RYGB. Although, ideally all theraputic options should be discussed during informed consent, this may not be happening as regularly as is being anticipated. This is of particular importance as multiple studies have found EGDE to be a cost-effective procedure, and to have shorter procedure time and hospital stay while having similar success rates and adverse events as LA-ERCP.


Disclosures:


Katherine Kendrick, MD¹, Mina Rismani, MD², Wesley Jones, MD¹, Veeral M. Oza, MD¹. P0858 - Are All Options Being Discussed in Patients With Choledocholithiasis and a History of Gastric Bypass?, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.