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

Patrick B. Schwartz, Jeffrey J. Easler, William P. Lancaster, Michael House, Nicholas Zyromski, C. Schmidt, Attila Nakeeb, Eugene P. Ceppa

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)41-47
Number of pages7
JournalJournal of Surgical Research
Volume238
DOIs
StatePublished - Jun 1 2019

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Transhepatic Sphincterotomy
Sphincter of Oddi Dysfunction
Gastric Bypass
Morbidity
Mortality
Therapeutics
Obesity
Gastrostomy
Endoscopic Retrograde Cholangiopancreatography

Keywords

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

ASJC Scopus subject areas

  • Surgery

Cite this

Sphincter of Oddi Dysfunction After Gastric Bypass : Surgical or Endoscopic Therapy? / Schwartz, Patrick B.; Easler, Jeffrey J.; Lancaster, William P.; House, Michael; Zyromski, Nicholas; Schmidt, C.; Nakeeb, Attila; Ceppa, Eugene P.

In: Journal of Surgical Research, Vol. 238, 01.06.2019, p. 41-47.

Research output: Contribution to journalArticle

Schwartz, Patrick B. ; Easler, Jeffrey J. ; Lancaster, William P. ; House, Michael ; Zyromski, Nicholas ; Schmidt, C. ; Nakeeb, Attila ; Ceppa, Eugene P. / Sphincter of Oddi Dysfunction After Gastric Bypass : Surgical or Endoscopic Therapy?. In: Journal of Surgical Research. 2019 ; Vol. 238. pp. 41-47.
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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.",
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T2 - Surgical or Endoscopic Therapy?

AU - Schwartz, Patrick B.

AU - Easler, Jeffrey J.

AU - Lancaster, William P.

AU - House, Michael

AU - Zyromski, Nicholas

AU - Schmidt, C.

AU - Nakeeb, Attila

AU - Ceppa, Eugene P.

PY - 2019/6/1

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N2 - 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.

AB - 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.

KW - Endoscopy

KW - ERCP

KW - Obesity

KW - Roux-en-Y

KW - Sphincteroplasty

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