P0053 - Comparative Outcomes of Endoscopic Retrograde Cholangiopancreatography in Patients With Choledocholithiasis Post-Roux-en-Y Gastric Bypass: A Multi-Center Retrospective Study

Hassam Ali, MD¹, Waqas Rasheed, MD², Shiza sarfraz, MD³, Fouad Jaber, MD⁴, Umar Hayat, MD⁵, Dushyant S. Dahiya, MD⁶, Amna Iqbal, MD⁷, Manesh Kumar Gangwani, MD⁸, Sheena shamoon, MD⁹, Ahsan Safdar, MBBS¹⁰, Douglas Adler, MD^11
1East Carolina University, Greenville, NC; ²University of Kentucky, Lexington, KY; ³East Carolina University Brody School of Medicine, Greenville, NC; ⁴University of Missouri - Kansas City School of Medicine, Kansas City, MO; ⁵Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA; ⁶The University of Kansas School of Medicine, Kansas City, KS; ⁷University of Toledo Medical Center, Toledo, OH; ⁸University of Toledo, Toledo, OH; ⁹Rawalpindini Medical College, Lahore, Punjab, Pakistan; ¹⁰Services Institute of Medical Sciences, Lahore, Punjab, Pakistan; ¹¹Center for Advanced Therapeutic (CATE), Centura Health, Porter Adventist Hospital, Peak Gastroenterology, Denver, CO

Introduction: Endoscopic Retrograde Cholangiopancreatography (ERCP) is essential for managing choledocholithiasis. Patients with a history of Roux-en-Y gastric bypass (RYGB) present unique anatomical challenges that may affect ERCP outcomes. This study aims to compare the outcomes of ERCP in patients with choledocholithiasis, with and without a history of RYGB.

Methods: This retrospective cohort study used data from the TrinteX US Collaborative Network, including patients aged 18 or older who underwent ERCP for choledocholithiasis from January 1, 1990, to June 1, 2024. Patients were stratified based on RYGB history. Propensity score matching (PSM) was performed to balance the two groups. Outcomes analyzed included procedural success, complications (pancreatitis, perforation, infection), length of hospital stay, and mortality rates.

Results: After matching, both groups included 459 patients each, with a mean age of 58.9 ± 15.2 years in the RYGB group and 58.8 ± 15.3 years in the non-RYGB group (p=0.88). Male sex was 40.3% in the RYGB group versus 41.0% in the non-RYGB group (p=0.84). Procedural success rates were similar between the groups (90% in RYGB group vs. 89% in non-RYGB group). Acute cholangitis (14.10% vs. 7.93%, p=0.003; OR: 1.90, 95% CI: 1.23-2.93), antibiotic use (24.89% vs. 16.96%, p=0.003; OR: 1.62, 95% CI: 1.17-2.24), ICU care (10.35% vs. 6.39%, p=0.031; OR: 1.69, 95% CI: 1.04-2.74;) and cholecystectomy was more frequent in the RYGB group (6.17% vs. 2.20%, p=0.002; OR: 2.91, 95% CI: 1.4-6.08) compared to those without RYGB (Figure 1). Mortality rates (2.20% vs. 3.74%, p=0.171), bile duct perforation (2.20% in both groups, p=1.00), re-hospitalization rates (59.25% vs. 59.69%, p=0.8925), acute pancreatitis (13.88% vs. 16.52%, p=0.26), and post-procedural bleeding (2.20% in both groups, p=1.00) showed no significant differences between the groups.

Discussion: This study demonstrates that ERCP outcomes for choledocholithiasis are generally comparable between patients with and without a history of RYGB. However, the RYGB group exhibited higher rates of acute cholangitis, antibiotic use, ICU care, and cholecystectomy. These findings suggest that while ERCP is effective in both groups, patients with a history of RYGB may require closer monitoring and management of specific complications.



Disclosures:


Hassam Ali, MD¹, Waqas Rasheed, MD², Shiza sarfraz, MD³, Fouad Jaber, MD⁴, Umar Hayat, MD⁵, Dushyant S. Dahiya, MD⁶, Amna Iqbal, MD⁷, Manesh Kumar Gangwani, MD⁸, Sheena shamoon, MD⁹, Ahsan Safdar, MBBS¹⁰, Douglas Adler, MD¹¹. P0053 - Comparative Outcomes of Endoscopic Retrograde Cholangiopancreatography in Patients With Choledocholithiasis Post-Roux-en-Y Gastric Bypass: A Multi-Center Retrospective Study, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.