Laparoscopy-assisted transgastric endoscopic retrograde cholangiopancreatography for choledocholithiasis after Roux-en-Y gastric bypass: A case report

Abstract

Background Exclusion of the stomach after Roux-en-Y gastric bypass (RYGB) makes access to the biliary tree very challenging for the surgeon or the endoscopist. Different techniques have been described to overcome this downside, including laparoscopy-assisted transgastric endoscopic retrograde cholangiopancreatography (ERCP), which is an outstanding method to access the remnant stomach in order to reach the duodenal papilla. The use of this technique is associated with a high success rate. Presentation of case Here we present the case of a 57-year-old patient with altered RYGB anatomy. The patient underwent laparoscopic cholecystectomy. Intraoperative cholangiography revealed the presence of a stone in the common bile duct. A laparoscopy-assisted transgastric ERCP was performed successfully. During the procedure, the duodenoscope was introduced through a gastrostomy, obviating the need for an intragastric trocar. The patient evolved favorably and was discharged on second postoperative day without any complications. Discussion Transgastric laparoscopy-assisted ERCP represents an effective approach for the management of biliary complications after RYGB, even if there is a long interval between the two interventions, as occurred in the present case. Other methods described for accessing the biliary tree in patients with altered RYGB anatomy are double-balloon ERCP and endoscopic ultrasound-directed transgastric ERCP. We elected to perform the laparoscopy-assisted approach because choledocholithiasis was diagnosed transoperatively, thus, avoiding the need for secondary procedures or interventions. Conclusion Transgastric laparoscopy-assisted ERCP is a feasible procedure with low complication rates and is used in treating patients with altered RYGB anatomy who present with biliary tract disorders. The use of transgastric laparoscopy-assisted ERCP allows endoscopic treatment and cholecystectomy to be performed in a single setting.

Artificial Intelligence‐Assisted Visual Sensing Technology under Duodenoscopy of Gallbladder Stones

“…What is more, the therapeutic effect of the biliary function index of the AI group was also much better than that of the conventional group. The above results are consistent with most other complication rates after treatment with laparoscopy combined with duodenoscope for treatment of gallbladder stones combined with common bile duct stones [4,5,[26][27][28], providing support for laparoscopy combined with duodenoscope in the treatment of gallstones. Of course, AI-assisted visual sensing technology shows a wide range of applications, not just for assisted endoscopic treatment of gallbladder stones, which has been illustrated in a number of studies on the optimization of colonoscopy bowel preparation and the establishment and preliminary verification of the artificial intelligence-assisted colorectal polyp identification system [29][30][31][32].…”

Management of combined malignant biliary-duodenal obstruction in Roux-en-Y gastric bypass anatomy with EUS-guided gastrogastrostomy, EUS biliary drainage, and duodenal stent placement

“…EUS-guided gastrogastrostomy facilitates access to the pancreaticobiliary system and enables us to perform additional procedures. 1 , 2 , 3 , 4 , 5 Here, we describe a case of a patient with RYGB anatomy undergoing EUS-guided gastrogastrostomy followed by EUS-guided fine-needle biopsy (EUS-FNB), EUS-guided biliary drainage, and duodenal stent placement.…”

“…EUS-guided gastrogastrostomy facilitates access to the pancreaticobiliary system and enables us to perform additional procedures. [1][2][3][4][5] Here, we describe a case of a patient with RYGB anatomy under-going EUS-guided gastrogastrostomy followed by EUSguided fine-needle biopsy (EUS-FNB), EUS-guided biliary drainage, and duodenal stent placement.A 58-year-old woman with RYGB anatomy presented with abdominal pain and jaundice. A CT scan showed a hypoattenuating ill-defined mass within the pancreatic head with vascular involvement, concerning for pancreatic…”

Successful treatment through staged laparoscopic transgastric endoscopic retrograde cholangiopancreatography for postoperative bile leakage: A case report

“…Altered endoscopic methods have been developed and are used in patients with surgically changed gastrointestinal anatomy, including balloon enteroscopy, laparoscopic-assisted transgastric endoscopic retrograde cholangiopancreatography (LA-ERCP), and percutaneous assisted transprosthetic endoscopic therapy. [5][6][7] Only a few case reports involving the use of LA-ERCP to treat postoperative bile leakage in patients with changed gastrointestinal anatomy have been published. [8][9][10] Here, we present the case of a 51-year-old man who developed bile leakage following laparoscopic exploration of the CBD.…”

“…Altered endoscopic methods have been developed and are used in patients with surgically changed gastrointestinal anatomy, including balloon enteroscopy, laparoscopic-assisted transgastric endoscopic retrograde cholangiopancreatography (LA-ERCP), and percutaneous assisted transprosthetic endoscopic therapy. [ 5 – 7 ]…”