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J Surg Res. 2019 Jun;238:41-47. doi: 10.1016/j.jss.2019.01.013. Epub 2019 Feb 6.

Sphincter of Oddi Dysfunction After Gastric Bypass: Surgical or Endoscopic Therapy?

Author information

1
Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
2
Department of Gastroenterology, Advanced Endoscopy, Indiana University School of Medicine, Indianapolis, Indiana.
3
Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana. Electronic address: eceppa@iupui.edu.

Abstract

BACKGROUND:

Management of Sphincter of Oddi Dysfunction (SOD) requires advanced techniques (endoscopic retrograde cholangiopancreatography via gastrostomy [GERCP]) after Roux-en-Y gastric bypass (RYGB) for obesity. Transduodenal sphincteroplasty (TS) is also performed yet carries the risks of surgery. We hypothesized that TS would have increased morbidity and mortality but provide a more durable remission of symptoms.

METHODS:

All patients between 2005 and 2016 with RYGB for obesity undergoing endoscopic or surgical management for type I or II SOD were included in the study. Patients with type III SOD, or who underwent RYGB for nonobesity indications, were excluded.

RESULTS:

Thirty-eight patients were identified. GERCP was initially performed in 17 patients, whereas TS was performed in 21. Thirty-day mortality was 0% in our cohort, and 30-d morbidity was similar between GERCP and TS (29% versus 10%; P = 0.207). Resolution of symptoms after initial therapy was seen in 41% of GERCP (7/17) and 67% of TS (14/21) (P = 0.190), respectively, and overall after 35% (8/23) and 64% (16/24) of procedures performed (P = 0.042). Symptom resolution, as defined by the median ratio of days of total remission by total days of observed follow-up, was shorter after initial and all interventions with GERCP compared with TS (0.67 versus 1.00, P = 0.036 and 0.52 versus 1.00, P = 0.028, respectively).

CONCLUSIONS:

Endoscopic and surgical treatment of SOD had similar morbidity and mortality. However, treatment success and duration of remission was higher in those treated with surgery.

KEYWORDS:

ERCP; Endoscopy; Obesity; Roux-en-Y; Sphincteroplasty

PMID:
30738357
DOI:
10.1016/j.jss.2019.01.013

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