Transgastric Endoscopic Retrograde Cholangiopancreatography for the Management of Biliary Tract Disease after Roux-en-Y Gastric Bypass Treatment for Obesity

Abstract

Roux-en-Y gastric bypass (RYGB) is an effective treatment for morbid obesity. However, it may lead to diseases of the bilio-pancreatic tract. We evaluated transgastric endoscopic retrograde cholangiopancreatography (ERCP) for managing common biliary tract diseases in patients that underwent RYGB treatment for obesity. This prospective study was conducted between 2003 and 2010 at three medical institutions. We included 23 patients with a mean body mass index of 28.2 kg/m(2) after RYGB treatment. ERCP was performed in all patients to manage biliary tract diseases within 9 to 27 months (mean 16.3 months) of RYGB surgery. The gastrotomy was conducted through the anterior wall of the greater curve of the excluded stomach. A duodenoscope was introduced in the direction of the ostomy to perform the ERCP with sphincterotomy. All patients underwent an ERCP and papillotomy without incident. Ten patients underwent simultaneous cholecystectomy. A total of 17 gallstones were removed. The average gastrotomy duration was 92.69 min; the average hospital stay was 2 days. One patient had mild acute pancreatitis that resolved clinically. There was no mortality. Laparoscopy-assisted transgastric ERCP was feasible and safe for patients after RYGB. The necessary equipment is available in most bariatric surgery centers.

The Incidence of Cholelithiasis After Corrective Weight Loss Surgery.

“…In our study we found 5.8 % of sleeve patients and 6.4 % of LRYGB patients, already had their gallbladder removed or had gallstone disease before the operation. This result is similar to that of other studies (16,18). Portenier et al (14) argued that the incidence of delayed cholecystectomy for symptoms or complications of gallstone formation was much lower than the ≥30% reported to develop gallstones and suggested an expectant approach of the asymptomatic cholelithiasis in LRYGB patients.…”

“…However, routine preoperative ultrasound screening for gallstones and/or prophylactic cholecystectomy may still be beneficial in LRYGB patients, because access to the biliary tract after LRYGB is challenging (18). In addition, positive gallstones in workups may interfere with diagnosing other reasons when the symptoms are not specific.…”

Approach of the Bile Duct by Gastrostomy in Patients With Bypass in Roux-en-Y Proved to Be Safe and Effective

“…Case series described in the literature point to success rates up to 100.0%, with complication rates similar to the traditional procedure [10,[43][44][45][46][47], demonstrating that it is technically superior to those using long frontal vision devices.…”

“…2017;7(4):58-63 the surgical team throughout the procedure are important factors that limit the diffusion of the use of this technique [10,[43][44][45][46][47].…”

“…Associating this fact with an increase in the number of patients submitted to this technique, a greater demand for interventions on the bile ducts is expected. In view of the anatomical changes determined by this surgery [10], the challenge of accessing the biliary tract in these patients is imposed on endoscopists.…”