Surgical Endoscopy

, Volume 30, Issue 10, pp 4647–4652 | Cite as

Laparoscopic-assisted ERCP and EUS in patients with prior Roux-en-Y gastric bypass surgery: a dual-center case series experience

  • Erik BowmanEmail author
  • Jacob Greenberg
  • Michael Garren
  • Nalini Guda
  • Brian Rajca
  • Mark Benson
  • Patrick Pfau
  • Anurag Soni
  • Andrew Walker
  • Deepak Gopal
Dynamic Manuscript



Patients with Roux-en-Y gastric bypass (RYGB) develop pancreatobiliary issues after surgery. Endoscopic management via the conventional route with endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) is quite limited due to the altered anatomy. Laparoscopic-assisted ERCP (LA-ERCP) via the excluded stomach has been highly successful. Reported use of laparoscopic-assisted EUS (LA-EUS) is extremely rare.


A retrospective review was conducted at two tertiary referral centers for cases that involved laparoscopic-assisted ERCP and EUS. Patient demographic data were collected along with data regarding procedure, indication, complications and length of stay.


A total of 16 cases involving 15 patients were identified: 11 cases of LA-ERCP and five cases of combined LA-EUS plus LA-ERCP were performed. Four patients had previously undergone failed endoscopy via the conventional route (27 %). There was a 100 % biliary/pancreatic cannulation and intervention rate. There were no endoscopic-related complications. Therapeutic interventions included laparoscopic cholecystectomy, lysis of adhesions, biliary and pancreatic sphincterotomy, biliary and pancreatic stent placement, stone removal including mechanical lithotripsy and EUS biopsy and diagnosis of pancreatic cancer. Average discharge was on postoperative day 3.4. However, 50 % were discharged after 1 day.


LA-ERCP and combined LA-EUS plus LA-ERCP are safe and highly successful diagnostic and therapeutic modalities for a wide variety of pancreatobiliary ailments in RYGB patients.


ERCP EUS Roux-en-Y gastric bypass Laparoscopic assisted 


Compliance with ethical standards


Jacob Greenberg speaks for Covidien and receives research support and consults for Covidien and Bard-Davol. Nalini Guda serves as a consultant for Boston Scientific Corporation. Drs Bowman, Garren, Rajca, Benson, Pfau, Soni, Walker and Gopal have no conflict of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (MOV 29152 kb)

Supplementary material 2 (MOV 16871 kb)

Supplementary material 3 (MOV 20668 kb)

Supplementary material 4 (MOV 27894 kb)


  1. 1.
    Buchwald H, Oien DM (2013) Metabolic/bariatric surgery worldwide 2011. Obes Surg 23(4):427–436CrossRefPubMedGoogle Scholar
  2. 2.
    Shiffman ML, Sugerman HJ, Kellum JM, Brewer WH, Moore EW (1991) Gallstone formation after rapid weight loss: a prospective study in patients undergoing gastric bypass surgery for treatment of morbid obesity. Am J Gastroenterol 86(8):1000–1005PubMedGoogle Scholar
  3. 3.
    Shiffman ML, Sugerman HJ, Kellum JM, Moore EW (1992) Changes in gallbladder bile composition following gallstone formation and weight reduction. Gastroenterology 103(1):214–221CrossRefPubMedGoogle Scholar
  4. 4.
    Moreels TG (2013) ERCP in the patient with surgically altered anatomy. Curr Gastroenterol Rep 15(9):343CrossRefPubMedGoogle Scholar
  5. 5.
    Samarasena JB, Nguyen NT, Lee JG (2012) Endoscopic retrograde cholangiopancreatography in patient with roux-en-Y anatomy. J Interv Gastroenterol 2(2):78–83CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Wright BE, Cass OW, Freeman ML (2002) ERCP in patients with long-limb Roux-en-Y gastrojejunostomy and intact papilla. Gastrointest Endosc 56(2):225–232CrossRefPubMedGoogle Scholar
  7. 7.
    Roberts KE, Panait L, Duffy AJ, Jamidar PA, Bell RL (2008) Laparoscopic-assisted transgastric endoscopy: current indications and future implications. JSLS 12(1):30–36PubMedPubMedCentralGoogle Scholar
  8. 8.
    Gutierrez JM, Lederer H, Krook JC, Kinney TP, Freeman ML, Jensen EH (2009) Surgical Gastrostomy for pancreatobiliary and duodenal access folloowing Roux en Y gastric bypass. J Gastrointest Surg 13(12):2170–2175CrossRefPubMedGoogle Scholar
  9. 9.
    Lopes TL, Clements RH, Wilcox CM (2009) Laparoscopy-assisted ERCP: experience of a high-volume bariatric surgery center (with video). Gastrointest Endosc 70(6):1254–1259CrossRefPubMedGoogle Scholar
  10. 10.
    Bertin PM, Singh K, Arregui ME (2011) Laparoscopic transgastric endoscopic retrograde cholangiopancreatography (ERCP) after gastric bypass: case series and a description of technique. Surg Endosc 25(8):2592–2596CrossRefPubMedGoogle Scholar
  11. 11.
    Wilson JA, Hoffman B, Hawes RH, Romagnuolo J (2010) EUS in patients with surgically altered upper GI anatomy. Gastrointest Endosc 72(5):947–953CrossRefPubMedGoogle Scholar
  12. 12.
    Ramesh J, Christein J, Varadarajulu S (2013) The concept of laparoscopy-assisted pancreatobiliary EUS (LAP-EUS). J Gastrointest Surg 17(5):1020–1023CrossRefPubMedGoogle Scholar
  13. 13.
    Shah RJ, Smolkin M, Yen R, Ross A, Kozarek RA, Howell DA, Bakis G, Jonnalagadda SS, Al-Lehibi AA, Hardy A, Morgan DR, Sethi A, Stevens PD, Akerman PA, Thakkar SJ, Brauer BC (2013) A multicenter, US experience of single-balloon, double-balloon, and rotational overtube-assisted enteroscopy ERCP in patients with surgically altered pancreatobiliary anatomy (with video). Gastrointest Endosc 77(4):593–600CrossRefPubMedGoogle Scholar
  14. 14.
    Saleem A, Levy MJ, Petersen BT, Que FG, Baron TH (2012) Laparoscopic assisted ERCP in Roux-en-Y gastric bypass (RYGB) surgery patients. J Gastrointest Surg 16(1):203–208CrossRefPubMedGoogle Scholar
  15. 15.
    Richardson JF, Lee JG, Smith BR, Nguyen B, Pham KP, Nguyen NT (2012) Laparoscopic transgastric endoscopy after Roux-en-Y gastric bypass: case series and review of the literature. Am Surg 78(10):1182–1186PubMedGoogle Scholar
  16. 16.
    Schreiner MA, Chang L, Gluck M, Irani S, Gan SI, Brandabur JJ, Thirlby R, Moonka R, Kozarek RA, Ross AS (2012) Laparoscopy-assisted versus balloon enteroscopy-assisted ERCP in bariatric post-Roux-en-Y gastric bypass patients. Gastrointest Endosc 75(4):748–756CrossRefPubMedGoogle Scholar
  17. 17.
    Attam R, Leslie D, Arain MA, Freeman ML, Ikramuddin S (2015) EUS-guided sutured gastropexy for transgastric ERCP (ESTER) in patients with Roux-en-Y gastric bypass: a novel, single-session, minimally invasive approach. Endoscopy. doi: 10.1055/s-0034-1391124 Google Scholar
  18. 18.
    Humphries R, McDonnell G (2015) Superbugs on duodenoscopes: the challenge of cleaning and disinfection of reusable devices. J Clin Microbiol 53(10):3118–3125CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    ASGE (2015) Transmission of CRE bacteria through endoscopic retrograde cholangiopancreatography (ERCP) interim guidance.

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Erik Bowman
    • 1
    Email author
  • Jacob Greenberg
    • 2
  • Michael Garren
    • 2
  • Nalini Guda
    • 3
  • Brian Rajca
    • 3
  • Mark Benson
    • 1
  • Patrick Pfau
    • 1
  • Anurag Soni
    • 1
  • Andrew Walker
    • 1
  • Deepak Gopal
    • 1
  1. 1.Division of Gastroenterology & Hepatology, Department of MedicineUniversity of Wisconsin Hospital & ClinicsMadisonUSA
  2. 2.Department of SurgeryUniversity of Wisconsin Hospital & ClinicsMadisonUSA
  3. 3.Division of GastroenterologyAurora St. Lukes Medical CenterMilwaukeeUSA

Personalised recommendations