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Common bile duct dilation after bariatric surgery

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Abstract

Background

Biliary dilation suggests obstruction and prompts further work up. Our experience with endoscopic ultrasound and endoscopic retrograde cholangiopancreatography in the symptomatic post-bariatric surgery population revealed many patients with radiographically dilated bile ducts, but endoscopically normal studies. It is unclear if this finding is phenomenological or an effect of surgery. Additionally, it is unknown whether the type of bariatric surgery alters biliary pathophysiology. Thus, we studied whether a change occurs in biliary diameter following Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG).

Methods

A single-center retrospective study assessing biliary diameter before and after RYGB or SG based on radiographic imaging. All adult patients undergoing RYGB or SG from January 2010 to December 2013 who had imaging studies before and > 3 months after surgery were included. Those with known obstructive etiologies and those without post-operative imaging were excluded. Common bile duct (CBD) diameter was re-read by a radiologist at the same location in the CBD for pre- and post-operative imaging. Baseline clinical factors and cholecystectomy status were collected.

Results

269 patients met inclusion criteria (193 RYGB;76 SG). Between the groups, there were no significant differences in pre-operative characteristics. Average time from surgery to repeat imaging was 24.1 months. After adjusting for pre-operative factors, subjects who underwent an RYGB had an increase in CBD diameter of 1.4 mm (95% CI 0.096, 0.18), which was greater than the change following SG 0.5 mm(95% CI − 0.007, 0.11). The magnitude of this change did not depend on prior cholecystectomy in the RYGB cohort. Within the SG group, for patients without a prior cholecystectomy, there was a significant increase in post-operative CBD diameter of 0.8 mm(95% CI 0.02, 0.14).

Conclusion

Bariatric surgery results in CBD dilation, with changes more pronounced after RYGB. Biliary dilation occurs irrespective of cholecystectomy status. Further work is necessary to determine the cause and clinical implications of this phenomenon.

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Authors and Affiliations

  1. Department of Internal Medicine, Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    Neal Mehta, Alfred Nelson & Ahmed Eltelbany

  2. Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    Andrew T. Strong, Kevin El-Hayek, John McMichael & Matthew Kroh

  3. Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    Tyler Stevens, Prabhleen Chahal, Maged Rizk, Carol A. Burke, John Vargo & Amit Bhatt

  4. Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    Adeyinka Owoyele & Joseph Veniero

  5. Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    Rocio Lopez

  6. Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Desk A30, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Amit Bhatt

Authors
  1. Neal Mehta
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Contributions

NM, ATS, TS, KE-H, PC, MR, CAB, JV, JV, MK, AB: role in manuscript preparation: concept and design; acquisition of data; analysis and/or interpretation of data; drafting of the manuscript and critical revision of the manuscript for important intellectual content. AN, AO, AE: role in manuscript preparation: acquisition of data. JM: Role in manuscript preparation: acquisition of data; analysis and/or interpretation of data. RL: role in manuscript preparation: analysis and/or interpretation of data; drafting of the manuscript and critical revision of the manuscript for important intellectual content.

Corresponding author

Correspondence to Amit Bhatt.

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Disclosures

Dr. Matthew Kroh is a consultant for Medtronic and Levita Magnetics. He also receives research funding from Cook. Dr. Amit Bhatt is a speaker for Aries Pharmaceuticals and a consultant for Medtronic. Neal Mehta, Andrew T. Strong, Tyler Stevens, Kevin El-Hayek, Alfred Nelson, Adeyinka Owoyele, Ahmed Eltelbany, Prabhleen Chahal, Maged Rizk, Carol A. Burke, John McMichael, Rocio Lopez, Joseph Veniero, John Vargo have no conflicts of interest or financial ties to disclose.

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Mehta, N., Strong, A.T., Stevens, T. et al. Common bile duct dilation after bariatric surgery. Surg Endosc 33, 2531–2538 (2019). https://doi.org/10.1007/s00464-018-6546-9

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