Obesity Surgery

, Volume 28, Issue 9, pp 2836–2843 | Cite as

Trans-Gastric ERCP After Roux-en-Y Gastric Bypass: Systematic Review and Meta-Analysis

  • Alberto Aiolfi
  • Emanuele Asti
  • Emanuele Rausa
  • Daniele Bernardi
  • Gianluca Bonitta
  • Luigi BonavinaEmail author
Original Contributions



Trans-oral endoscopic access to the pancreaticobiliary system is challenging after Roux-en-Y gastric bypass (RYGB). Trans-gastric ERCP (TG-ERCP) has emerged as a viable option to manage patients with symptomatic post-RYBG choledocolithiasis. The aim of this systematic review and meta-analysis was to examine the outcomes of TG-ERCP to better define the risk-benefit ratio of this procedure and to guide clinical decision-making.


A literature search was conducted to identify all reports on ERCP after RYGB. Pubmed, MEDLINE, Embase, and Cochrane databases were thoroughly consulted matching the terms “ERCP” AND “gastric bypass.” Pooled prevalence of ERCP success rate, ERCP-related morbidity, post-procedural infectious complications, and overall morbidity were calculated using Freeman-Tukey double arcsine transformation and DerSimonian-Laird estimator in random effect meta-analysis. Heterogeneity among studies was evaluated using I2-index and Cochrane Q test. Meta-regression was used to address the effect of potential confounders.


Thirteen papers published between 2009 and 2017 matched the inclusion criteria. Eight hundred fifty patients undergoing 931 procedures were included. The most common clinical indications for TG-ERCP were biliary (90%) and pancreatic (10%). The majority of patients underwent an initial laparoscopic approach (90%). Same-day ERCP was successfully achieved in 703 cases (75.5%). Pooled prevalence of ERCP success rate, ERCP-related morbidity, post-procedural infectious complications, and overall morbidity were 99% (95% CI = 98–100%), 3.1% (95% CI = 1.0–5.8%), 3.4% (95% CI = 1.7–5.5%), and 14.2% (95% CI = 8.5–20.8%), respectively.


TG-ERCP is a safe and effective therapeutic option in patients with symptomatic post-RYGB choledocolithiasis.


Transgastric ERCP (endoscopic retrograde cholangiopancreatography) Roux-en-y gastric bypass Transgastric Choledocolithiasis Complications 


Author contributions

A.A, E.R, D.B., and L.B did the literature search.

A.A and L.B. formed the study design.

Data collection was done by A.A, E.R, and D.B.

A.A, G.B. and L.B. analyzed the data.

A.A, E.A., and L.B interpreted the data.

A.A and L.B. wrote the manuscript.

A.A, E.A, and L.B critically reviewed the manuscript.

Compliance with Ethical Standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of Interest

The authors declare that they have no conflict of interest.

Informed Consent

Not applicable.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Biomedical Science for Health, Division of General Surgery IRCCS Policlinico San DonatoUniversity of MilanMilanItaly

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