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Review of the Endoscopic, Surgical and Radiological Techniques of Treating Choledocholithiasis in Bariatric Roux-en-Y Gastric Bypass Patients and Proposed Management Algorithm

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Abstract

Choledocholithiasis in post-surgical bariatric Roux-en-Y gastric bypass patients presents a significant challenge secondary to altered anatomy. We aim to review the existing management options including either endoscopic, surgical, percutaneous or hybrid means. Current literature suggests reasonably successful cannulation rates for single- or double-balloon ERCP ranging from 50 to 70% and 63–83%, respectively. The hybrid technique of laparoscopic transgastric ERCP has gained popularity with success rates ranging from 90 to 100%. Conventional laparoscopic techniques like transcystic duct and transcholedochal bile duct exploration are still useful options (i.e. high success rates of 81–100% and 83–96%, respectively). The role of percutaneous transhepatic choledochography remains limited although it can help with rapid bile duct decompression. If feasible, treatment pathways should progress from least to more invasive options as required.

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Authors and Affiliations

  1. Department of Upper Gastrointestinal Surgery, St George Hospital, Sydney, NSW, Australia

    Qiuye Cheng & Ken Loi

  2. Department of Surgery, Westmead Hospital, Sydney, NSW, Australia

    Qiuye Cheng, Amy Hort & Peter Yoon

  3. Upper Gastro-Intestinal Surgical Unit, St George Public Hospital, Gray St, Kogarah, NSW, 2217, Australia

    Qiuye Cheng

  4. The School of Medicine, The University of Sydney, Sydney, NSW, Australia

    Amy Hort & Peter Yoon

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Key Points

• Choledocholithiasis in previous Roux-en-Y gastric bypass bariatric patients should be managed in speciality bariatric/upper gastro-intestinal surgical services.

• Management techniques include endoscopic, surgical, radiological or hybrid methods to allow stone extraction and decompression of biliary tree.

• An escalatory approach to management should always be utilised with careful consideration of available centre-specific resources.

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Cheng, Q., Hort, A., Yoon, P. et al. Review of the Endoscopic, Surgical and Radiological Techniques of Treating Choledocholithiasis in Bariatric Roux-en-Y Gastric Bypass Patients and Proposed Management Algorithm. OBES SURG 31, 4993–5004 (2021). https://doi.org/10.1007/s11695-021-05627-z

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