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. 2022 Jan 6;2(1):e85.
doi: 10.1002/deo2.85. eCollection 2022 Apr.

Efficacy of endoscopic retrograde cholangiopancreatography in familial adenomatous polyposis patients after duodenectomy

Ravi S Shah  1 , Neal Mehta  1 , Carol A Burke  1 , Gautam Mankaney  1 , Tyler Stevens  1 , Toms Augustin  2 , Matthew R Walsh  2 , Amit Bhatt  1
Affiliations

Efficacy of endoscopic retrograde cholangiopancreatography in familial adenomatous polyposis patients after duodenectomy

Ravi S Shah et al. DEN Open. .

Abstract

Objectives: Familial adenomatous polyposis (FAP) patients with Spigelman stage IV polyposis should be considered for prophylactic duodenectomy. Post-surgical pancreaticobiliary complications occur and may require management via endoscopic retrograde cholangiopancreatography (ERCP). We aimed to assess the success and adverse events of ERCP in FAP patients after pancreas-sparing duodenectomy (PSD) and pancreaticoduodenectomy (PD).

Methods: A retrospective review of FAP patients who underwent ERCP after PSD or PD from 1992 to 2020 at a quaternary referral center was completed. The technical success of ERCP was defined as the ability to identify the anastomosis and cannulate the duct. Post-procedural adverse events were defined by bleeding, perforation, pancreatitis, or cholangitis. Clinical outcomes included the need for surgical intervention and recurrent pancreatitis after ERCP were assessed.

Results: Of 84 FAP patients with duodenectomy, 12 patients with PSD and two patients with PD underwent 17 ERCPs for pancreatic indications and five for biliary indications. The technical success of ERCP in patients with PSD and a single neoampullary complex for pancreatic (n = 6) and biliary (n = 5) indications was 100% but for those with PD (n = 2) or PSD reconstruction with pancreatic divisum or separate anastomoses (n = 3), it was 0%. Surgical intervention was required in 50% of patients with technically failed ERCP after PSD (2/4) and PD (1/2). There were no adverse events.

Conclusions: ERCP is expected to be therapeutically successful for biliary complications following PSD. Assessment and potential therapy for pancreatitis post-PSD are best in the setting of a single neo-ampullary complex rather than in PD or PSD with pancreatic divisum.

Keywords: adenomatous polyposis coli; cholangiopancreatography; endoscopic retrograde; endoscopy; gastrointestinal; pancreaticoduodenectomy; pancreatitis.

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Conflict of interest statement

Carol A. Burke has no relevant disclosures but has research support from Janssen Pharmaceuticals, Ferring Pharmaceuticals, and Cancer Prevention Pharmaceuticals and consulting fees from Freenome, Ferring Pharmaceuticals, and SLA Pharma. Amit Bhatt has no relevant disclosures but has royalties from Medtronics and consulting fees from Boston Scientific, Lumendi, Steris, Intuitive. All other authors do not have any conflict of interest.

Figures

FIGURE 1
FIGURE 1
(a) Pancreas‐sparing duodenectomy: single anastomosis (Arrow) and (b) Pancreaticoduodenectomy: separate biliojejunal and pancreaticojejunal anastomoses (Arrows)
FIGURE 2
FIGURE 2
Pancreas‐sparing duodenectomy with neo‐ampullary complex in the neo‐jejunum, guidewire in the pancreatic orifice, biliary orifice seen above
FIGURE 3
FIGURE 3
Patient cohort
FIGURE 4
FIGURE 4
Success rate of endoscopic retrograde cholangiopancreatography (ERCP) for pancreatic indications
FIGURE 5
FIGURE 5
Clinical outcomes for patients with endoscopic retrograde cholangiopancreatography (ERCP) post‐duodenectomy for pancreatic indications
FIGURE 6
FIGURE 6
Incomplete pancreatic divisum in pancreas‐sparing duodenectomy
See this image and copyright information in PMC

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