Advertisement

Endoscopic retrograde cholangiopancreatography and gastroduodenoscopy after Roux-en-Y gastric bypass

  • J. MartinezEmail author
  • L. Guerrero
  • P. Byers
  • P. Lopez
  • T. Scagnelli
  • R. Azuaje
  • B. Dunkin
Article

Abstract

Background

The use of Roux-en-Y gastric bypass (RYGB) for morbid obesity has raised concern that subsequent endoscopic evaluation of the gastric remnant and duodenum is difficult. By gaining percutaneous access to the gastric remnant, however, both gastroduodenoscopy and endoscopic retrograde cholangiopancreatography (ERCP) can be performed easily. This report describes the results of a novel technique for performing “transgastrostomy” gastroduodenoscopy and ERCP.

Methods

Six patients with a RYGB for morbid obesity underwent transgastric remnant endoscopic evaluations. If a gastric remnant tube had not been placed during prior surgery, one was placed percutaneously by an interventional radiologist. The tube tract then was dilated to either 20- or 24-Fr. At the time of endoscopy, the gastrostomy tube was removed and the skin anesthetized. Then either a pediatric duodenoscope (outer diameter, 7.5 mm) or a slim gastroscope (outer diameter, 5.9 mm) was inserted through the gastrostomy tube tract.

Results

Percutaneous gastroduodenoscopy was successfully performed for all six patients. The findings included two patients with prepyloric ulcers identified and assessed with a biopsy, one patient with intestinal metaplasia and a benign gastric polyp, and three patients with a normal gastric remnant and duodenum. A nonstrictured enteroenterostomy was noted in one of the three patients with a normal endoscopic evaluation. Percutaneous transgastrostomy ERCP was performed for three of the six patients who underwent gastroduodenoscopy. The findings included one patient who had papillary fibrosis treated with a sphincterotomy, a second patient with a normal biliary tree, and a third patient with a normal pancreatic duct. Selective cannulation of the common bile duct was not successful in the third patient.

Conclusion

The transgastrostomy endoscopic route ensures access to the excluded stomach and proximal small bowel after RYGB. This route is safe and effective, allowing the use of a duodenoscope to improve the cannulation success rate for ERCPs in this patient population.

Keywords

Bariatric Bilio CBD Common bile duct Endoscopy Endoscopic retrograde cholangiopancreatography ERCP Obesity 

References

  1. 1.
    Barmeir EP, Solomon H, Charuzi I, et al. (1984) Radiologic assessment of the distal stomach and duodenum after gastric bypass: percutaneous CT-guided transcatheter technique. Gastrointest Radiol 9: 203–205PubMedCrossRefGoogle Scholar
  2. 2.
    Elton E, Hanson BL, Qaseem T, Howell DA (1998) Diagnostic and therapeutic ERCP using an enteroscope and a pediatric colonoscope in long-limb surgical bypass patients. Gastrointest Endosc 47: 62–67PubMedCrossRefGoogle Scholar
  3. 3.
    Lord RV, Edwards PD, Coleman MJ (1997) Gastric cancer in the bypassed segment after operation of morbid obesity. Aust N Z J Surg 67: 580–582PubMedGoogle Scholar
  4. 4.
    Macgregor AM, Pickens NE, Thoburn EK (1999) Perforated peptic ulcer following gastric bypass for obesity. Am Surg 65: 222–225PubMedGoogle Scholar
  5. 5.
    Mergener K., Kozarek RA, Traverso LW (2003) Intraoperative transjejunal ERCP: case report. Gastrointest Endosc 58: 461–463PubMedGoogle Scholar
  6. 6.
    Peters M, Papasavas PK, Caushaj PF, Kania RJ, Gagne DJ (2002) Laparoscopic transgastric endoscopic retrograde cholangiopancreatography for benign common bile duct stricture after Roux-en-Y gastric bypass. Surg Endosc 16: 1106PubMedCrossRefGoogle Scholar
  7. 7.
    Printen KJ, LeFavre J, Alden J (1983) Bleeding from the bypassed stomach following gastric bypass. Surg Gynecol Obstet: 156: 65–66PubMedGoogle Scholar
  8. 8.
    Sinar DR, Flickinger EG, Park HK, Sloss RR (1985) Retrograde endoscopy of the bypassed stomach segment after gastric bypass surgery: unexpected lesions. South Med J 78: 255–258PubMedGoogle Scholar
  9. 9.
    Sundbom M, Nyman R, Hedenstöm H, Gustavsson S (2001) Investigation of the excluded stomach after Roux-en-Y gastric bypass. Obesity Surg 11: 25–27CrossRefGoogle Scholar
  10. 10.
    Wright BE, Cass OW, Freeman ML (2002) ERCP in patients with long-limb Roux-en-Y gastrojejunostomy and intact papilla. Gastrointest Endosc 56: 255–32PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • J. Martinez
    • 1
    Email author
  • L. Guerrero
    • 1
  • P. Byers
    • 1
  • P. Lopez
    • 1
  • T. Scagnelli
    • 1
  • R. Azuaje
    • 1
  • B. Dunkin
    • 1
  1. 1.Division of Laparoendoscopic and Bariatric SurgeryUniversity of Miami School of MedicineMiamiUSA

Personalised recommendations