C0630 - Incidence of Biliary Complications After Roux-en-Y Gastric Bypass Surgery

Monday, October 24, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Vibhu Chittajallu, MD

University Hospitals Cleveland Medical Center/ Case Western Reserve University
Cleveland, OH

Vibhu Chittajallu, MD¹, Abbinaya Elangovan, MD¹, Roberto Simons-Linares, MD²
¹University Hospitals Cleveland Medical Center/ Case Western Reserve University, Cleveland, OH; ²Cleveland Clinic Foundation, Cleveland, OH

Introduction: The incidence of biliary complications (BI) such as choledocholithiasis (CLD), cholangitis, gallstone acute pancreatitis (GAP), acute cholecystitis (AC) is not clear, and they pose a unique treatment challenge in patients with history of Roux-en-Y gastric bypass (RYGB) due to altered upper gastrointestinal anatomy. We aimed to identify the incidence of BI in RYGB patients.

Methods: Retrospective study from 1999 – 2022, using commercially available IBM Explorys database (Somers, NY), a de-identified cloud-based database. Diagnosis were based on Systematized Nomenclature of Medicine – Clinical Terms (SNOMED-CT). We identified patients with history of RYGB and excluded patients who had prior cholecystectomy. Among those who underwent RYGB, we identified our study population as those who developed new onset AC, GAP, CLD with or without cholangitis at least 30 days after RYGB. GAP was identified by including cases of acute pancreatitis plus CLD while excluding alcoholism, hypertriglyceridemia, and drug-induced pancreatitis. Among our study population, we evaluated those who underwent ERCP and cholecystectomy (CCY). Logistic regression models were constructed using as well as odds ratio analysis.

Results: We identified 19,450 patients who underwent RYGB, after exclusion of prior CCY, our final cohort had 9,490 RYGB patients; of which 930 patients (9.8%) had new onset BI after their RYGB, and were as follow: AC (710 patients, 7.6%), CLD without cholangitis (60 patients, 0.6%), CLD with cholangitis (50 patients, 0.5%), and GAP (40 patients (0.4%). 70% of AC cases were reported within 5 years of RYGB surgery. 370 patients (40%) underwent CCY and only 20 patients (2.2%) required ERCP for CLD. BI patients were more likely to be elderly, Caucasian, and had higher rates of diabetes mellitus type II and hyperlipidemia. Those who underwent CCY were less likely to be African American or to have comorbidities of diabetes mellitus type II and cardiovascular disease.

Discussion: Among patients who underwent RYGB, nearly 10% of patients developed new onset biliary complications. Of which, 40% required cholecystectomy post-RYGB, and 2% required ERCP post-RYGB. Our study found that the incidence of biliary complications post-RYGB is high and is likely to be of multifactorial etiology, such as rapid onset weight loss, malabsorption, and other possible mechanisms that still need to be elucidated. Further studies are needed to investigate if CCY at the time of RYGB is needed.

Figure: Table 1: Clinical Characteristics of RYGB Patients With and Without Biliary Complications

Demographics		Adults with cholecystectomy		Adults without cholecystectomy		OR	CI	p valve
Age	Adults	260	70%	370	66%	1
Age	Elderly	110	30%	190	34%	0.82	0.62-1.09	0.18
Gender	Male	70	19%	120	21%	1
Gender	Female	300	81%	440	79%	1.17	0.84-1.62	0.35
Race	Caucasian	320	86%	480	86%	1
Race	African American	30	8%	100	18%	0.45	0.29-0.69	0.0003
Medical comorbidities	DM2	110	30%	280	50%	0.42	0.32-0.56	< 0.0001
	HLD	160	43%	360	64%	0.8	0.60-1.09	0.161
	CVD/ PVD/ CAD	50	14%	110	20%	0.64	0.44-0.92	0.016

Table: Table 2: Comparison of RYGB Patients with Biliary Complications and Need for Cholecystectomy

Disclosures:

Vibhu Chittajallu indicated no relevant financial relationships.

Abbinaya Elangovan indicated no relevant financial relationships.

Roberto Simons-Linares indicated no relevant financial relationships.

Vibhu Chittajallu, MD¹, Abbinaya Elangovan, MD¹, Roberto Simons-Linares, MD². C0630 - Incidence of Biliary Complications After Roux-en-Y Gastric Bypass Surgery, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.