P3463 - Characteristics and Predictors of Adverse Post ERCP Outcomes in Patients With Roux-en-Y Gastric Bypass (RYGB) Surgery

Subash Ghimire, MD¹, Rasmita Budhathoki, MD¹, Amlish Gondal, MD¹, Tsu Jung Yang, MD¹, Michelle Bernshteyn, MD¹, Conor Banta, ², Vivian Deng, MS³, Madeline Mylod, MS³, Noah West, MS³, Sohaib Shabih, MD¹, Bibek Karki, MD, MPH⁴, Daebin Im, MD, MPH¹, Michael Georgetson, MD¹, Thomas McDonald, MD^1
1Guthrie Robert Packer Hospital, Sayre, PA; ²Geisinger Commonwealth School of Medicine, Sayre, PA; ³Lake Erie College of Osteopathic Medicine, Sayre, PA; ⁴Hurley Medical Center, Flint, MI

Introduction: Roux-en-Y gastric bypass (RYGB) surgery is one of the most common bariatrics surgeries and it alters the normal anatomy of upper gastrointestinal tract. This prohibits usual access to the major papilla and necessitates alternate ERCP approach. Laparoscopic-assisted ERCP (LA-ERCP) is one of the approaches taken for access. Prior studies have reported varying rates of complications related to the procedure. We performed this study to characterize patients with RYGB undergoing LA-ERCP and identify predictors for complications related to it.

Methods: This was a retrospective study of previous 10-year data on ERCP performed in RYGB patients at a tertiary care center hospital. Event rates of major adverse events in 30 days (perforation, Post ERCP pancreatitis, pneumonia, IC admission, cardiac arrest, perforation, death) were identified through retrospective chart review. Patient characteristics and demographics were summarized described, continuous data were compared with t-test and chi-square analysis using SPSS. Binary regression analysis for predictors of poor outcomes was performed. P value < .05 was used for statistical significance.

Results: We identified 85 patients with RYGB who underwent ERCP procedure. The mean age was 53.94 years with 81.2% females. Hypertension was the most common comorbidity (54%), followed by Diabetes mellitus (36.5%) and coronary artery disease (24.7%). Post procedure pneumonia was the most common complication (18%), followed by readmission (8.2%), post-ERCP pancreatitis (5.9%). There were no deaths or perforations. Binary regression for predictors of all cause complications showed results significant for COPD (OR= 2.917, p= .022, 95% CI= 2.209- 3.576) and coronary artery disease (OR= 3.014, p= .016, 95% CI= 2.889- 6.330)

Discussion: Our study is one of the largest reported outcomes of ERCP on patients undergoing Roux-en-Y gastric bypass (RYGB) surgery. Our analysis reveals a predictable increase in major adverse events in patients with COPD and coronary artery disease. Prospective studies are required to validate the above important findings and caution to avoid aspiration leading to pneumonia should be implemented in clinical practice in this population.



Disclosures:


Subash Ghimire, MD¹, Rasmita Budhathoki, MD¹, Amlish Gondal, MD¹, Tsu Jung Yang, MD¹, Michelle Bernshteyn, MD¹, Conor Banta, ², Vivian Deng, MS³, Madeline Mylod, MS³, Noah West, MS³, Sohaib Shabih, MD¹, Bibek Karki, MD, MPH⁴, Daebin Im, MD, MPH¹, Michael Georgetson, MD¹, Thomas McDonald, MD¹. P3463 - Characteristics and Predictors of Adverse Post ERCP Outcomes in Patients With Roux-en-Y Gastric Bypass (RYGB) Surgery, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.