Endosc Int Open 2015; 03(05): E458-E463
DOI: 10.1055/s-0034-1392108
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Laparoscopy-assisted transgastric endoscopic retrograde cholangiopancreatography in bariatric Roux-en-Y gastric bypass patients

Christophe Snauwaert
1  Cliniques Universitaires Saint-Luc, Brussels, Belgium
2  AZ Sint-Jan Hospital Brugge-Oostende, Bruges, Belgium
,
Pierre Laukens
2  AZ Sint-Jan Hospital Brugge-Oostende, Bruges, Belgium
,
Bruno Dillemans
2  AZ Sint-Jan Hospital Brugge-Oostende, Bruges, Belgium
,
Jacques Himpens
3  AZ Sint-Blasius General Hospital, Dendermonde, Belgium
,
Danny De Looze
4  Ghent University Hospital, Ghent, Belgium
,
Pierre Henri Deprez
1  Cliniques Universitaires Saint-Luc, Brussels, Belgium
,
Abdenor Badaoui
5  Mont-Godinne University Hospital, Yvoir, Belgium
› Author Affiliations
Further Information

Publication History

submitted 06 February 2015

accepted after revision 02 April 2015

Publication Date:
23 June 2015 (online)

Background: Performing endoscopic retrograde cholangiopancreatography in bariatric patients who underwent Roux-en-Y gastric bypass surgery is challenging due to the long anatomical route required to reach the biliopancreatic limb.

Aim: Assessment of the feasibility and performance of laparoscopy-assisted transgastric endoscopic retrograde cholangiopancreatography.

Methods: A retrospective multicenter observational consecutive-patient cohort study of all patients in the period May 2008 to September 2014 with a history of Roux-en-Y gastric bypass who presented with complicated biliary disease and who underwent a laparoscopy-assisted transgastric endoscopic retrograde cholangiopancreatography. The laparoscopy-assisted transgastric endoscopic retrograde cholangiopancreatography procedure was similar in all centers and was performed through a 15 mm or 18 mm trocar that was inserted in the gastric remnant. Cholecystectomy was performed concomitantly when indicated.

Results: In total, 23 patients underwent a laparoscopy-assisted transgastric endoscopic retrograde cholangiopancreatography procedure. Two patients required a mini-laparotomy for transgastric access because of a complex surgical history resulting in multiple adhesions. Indications included ascending cholangitis, choledocholithiasis, and biliary pancreatitis. Of the 23 patients, 13 underwent concomitant cholecystectomy. All patients successfully underwent biliary cannulation and sphincterotomy. No endoscopic procedure-related complications (i. e. bleeding, pancreatitis or retroperitoneal perforation) occurred. Mean hospital stay was 2.8 days (range 2 – 4).

Conclusions: Transgastric endoscopic retrograde cholangiopancreatography is a feasible approach in the treatment of pancreaticobiliary disease in Roux-en-Y gastric bypass patients, without major complications in our series and allows endoscopic treatment and cholecystectomy to be performed consecutively in a single procedure. In Roux-en-Y gastric bypass patients without a history of prior cholecystectomy presenting with complicated gallstone disease, combining cholecystectomy and transgastric endoscopic retrograde cholangiopancreatography as a first-line approach may be a valid treatment strategy.